Publications Order Form
To order publications, print this form and send it to : Bazelon Center
for Mental Health Law
1101 15th Street NW, Suite 1212, Washington, DC 20005-5002 Fax: 202-223-0409
Publications Ordered
Item # Quantity Copy Price Total Price
_____ _______ $_______ $_______
_____ _______ $_______ $_______
_____ _______ $_______ $_______
Total for publications $_______
If using purchase order, add $__4.50_
Shipping (see below) $_______
TOTAL $_______
Method of Payment
|_| Check enclosed |_| Purchase order # ______________________
(add $4.50 administrative charge to order)
|_| Visa or |_| MasterCard
________ ________ ________ ________ Expiration date ____/____
Credit Card #; please include all digits
___________________________________________________________
Signature
___________________________________________________________
Name
___________________________________________________________
Organization
___________________________________________________________
Address
___________________________________________________________
___________________________________________________________
City State Zip Code
Amt. of Order Shipping
$1 - $5 $2
$5.0l - $30 $4
$30.01 - $70 $8
$70.01 - $100 $11
$100+ $13
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To the Bazelon Center's home page.
Bazelon Center for Mental Health Law -- pubs@bazelon.org
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