Order
form for videotapes and DVDs of the 6th Annual William T. Small,
Jr. Keynote Lecture by Mary
E. Northridge, Ph.D., M.P.H.
|
| Payment
of $16 per tape and $18 per DVD by check, money order,
or credit card must be received for orders to be processed.
To order, complete this form and submit it online or mail
or fax it with your check or credit card information to
us at the address below. If you submit the form online,
please mail your check or telephone your credit card information.
Mail, fax, or telephone your payment to:
| Office
of Continuing Education |
Telephone:
1-919-966-4032 |
| Campus
Box 8165 |
Fax:
1-919-966-5692 |
| UNC-CH
School of Public Health |
|
| Chapel
Hill, NC 27599-8165 |
State
Courier Code 17-61-04 |
Please
make the checks payable to "School of Public Health/Office
of Continuing Education"
All orders should be received
by May 31st, 2004 and payments must be received by June
7th, 2004. All paid orders will be shipped by June 21st,
2004.
Please provide the information below
and then click the SUBMIT button.
Items marked with an * are required.
|
|
| |
| If
faxing or mailing your credit card information, please provide: |
| Type
of card: ____
Visa _____
MasterCard |
| Name
on card: ______________________________________________ |
| Account
number: _______________________ Expiration date: ________ |
| Signature:
_______________________ Date: ________ |
Office
of Continuing Education | North Carolina Institute for Public
Health
Campus Box 8165 | UNC School of Public Health | Chapel Hill,
NC 27599
Phone 919-966-4032 | Fax 919-966-5692 | E-mail oce@unc.edu
|
|