SUBSCRIPTION FAX/MAIL FORM

PHI DELTA KAPPAN
THE PROFESSIONAL JOURNAL FOR EDUCATION

PLEASE ENTER MY INDIVIDUAL:

____ One-Year Subscription (10 issues) for $63
____ Two-Year Subscription (20 issues) for $105
____ Three-Year Subscription (30 issues) for $140

____ Add $15.00 per subscription per year for non-US delivery

MAILING INFORMATION
Department or name and title of the person to whom the subscription should be addressed:

________________________________________________________________

Address to which the subscription should be sent:

Institution ________________________________________________________

Street/P.O. Box ___________________________________________________

City/State/Zip or Postal Code_________________________________________

Country _________________________________________________________

E-Mail _______________________ Daytime Ph. _______________________

NOTE: Telephone number and complete and accurate mailing address are especially important for timely and accurate delivery of all subscriptions. Please note that many schools and universities have a centrally located mailing address. Please check to make sure that you are using an address certified by the US Postal Service.

_____ This is a gift subscription. Please send a gift card to the recipient.

ORDER INFORMATION

Name of person placing the order:__________________________________________

Institution _____________________________________________________________

Street/P.O. Box ________________________________________________________

City/State/Zip or Postal Code______________________________________________

Country ______________________________________________________________

E-Mail _______________________ Daytime Ph. _______________________

Purchase Order Number ___________________________

Please bill my ___MasterCard ___VISA ___American Express ___Discover

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Acct. No.

___ ___ / ___ ___ ___ ___
Exp. Date

__________________________________________
Signature (Required)

Mail this entire form and payment (in U.S. dollars) to: Phi Delta Kappa International, Subscription Dept., P.O. Box 789, Bloomington, IN 47402-0789, Phone: 800/766-1156. Or fax the form with your credit card information to: 812/339-0018.