Tuberculosis Case Management CD-ROM
Order Form

(Print or download form: fax to 301-941-8427 or e-mail to [email protected])

Full Name:   

Title:

Company Name: 

Address : 

City:

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Country:

ZIP/Postal Code:

Email Address:

Daytime Phone:

Fax:  

Please provide a brief description of your duties related to tuberculosis (TB) case management:

Do you perform any training related to TB? If so, please describe briefly:

How did you find out about this product:

Quality Assurance Projectís prices apply only to orders from North America, Australia, and Western Europe and include shipping and handling. Individuals or organizations in developing countries with headquarters in North America, Australia, and Western Europe must prepay the prices listed on this order form. All funds received are used to provide publications to non-sponsored individuals in Africa, Southeast Asia, the Caribbean, Eastern Europe, and Latin America, for whom products are free of charge.

 

Tuberculosis Case Management CD-ROM

1-5

$20.00 each (includes shipping)

 

 

 

$ __________

6-15

$15.00 each (includes shipping)


________

$___________

16 or more

$10.00 each (includes shipping)


________

$___________

Single copies are available free of charge to developing country professionals

Please remit payment by check or money order only:

Make checks and money orders payable to University Research Co., LLC . Mail payment with your order.

Ä Passport # (driverís license # for U.S. residents): ________________________________________

Signature: _______________________________________Phone #: _______________________


Communication Division
Quality Assurance Project
7200 Wisconsin Ave, Suite 600
Bethesda, MD 20814-4811
Phone
Phone: 301-941-8532
Fax: 301-941-8427
e-mail
[email protected]