SAFE PRACTICES GUIDE

MAIL ORDER FORM

To order -- please complete each field below:
Name:

Company:

Phone:

Fax:

E-Mail:

Mailing Address:


City/Town:

State:

Postal Code:
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Country:

Number of copies at $19.95 each: 
Shipping & Handling @ $5.00 for 1st book: 
Shipping & Handling @ $3.00 each for add'tl bks to same address: 
Total Order $US: 
                        Foreign address requires a $10 airmail postage fee.
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Other Questions or Comments:

After filling in above information
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AND MAIL WITH YOUR CHECK TO:
Christopher S. Walsh, M.D.
Virginia Radiation Therapy and Oncology, P.C.
PO Box 8510
Fredericksburg, VA 22404

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