Medical Response to Weapons of Mass Destruction CD-ROM Order Form

INSTRUCTIONS: 1. Complete all areas of this form as indicated and click Submit. 2. A printable version will be displayed. Confirm your information, then print your completed form. 3. Mail form to the address given, along with cash (USD only), check, or money order for the amount indicated. 4. You will receive an e-mail confirmation when your order and payment arrive. All fields in bold type are required.
Your name:
Your organization (optional):
Mailing address:
Contact e-mail address:
Number of CDs @ $20 USD each:
Shipping & Handling:	First Class mail (3-5 business days, within continental U.S. only) - $3.95 (NOTE: Includes S&H for up to 10 CDs. Add $2.95 for each additional increment or partial increment of 10 CDs.) Priority mail (2-3 business days, within continental U.S. only) - $10.95 (NOTE: Includes S&H for up to 10 CDs. Add $7.95 for each additional increment or partial increment of 10 CDs. Deliveries to P.O. boxes may take longer.) Outside continental U.S. (10-16 business days, includes AK, HI, and PR) - $19.95 (NOTE: Includes S&H for up to 10 CDs. Add $15.95 for each additional increment or partial increment of 10 CDs)