Order form – Please print, then mail or fax:
Please supply the IFOMT-2000 CD-ROM, inclusive of GST, postage and
handling
Quantities: ……… x IFOMT-2000 Proceedings CD-ROM @ A$30.00 each
TOTAL VALUE A$ ..........................
Payment: [international] Bank Cheque in Australian dollars: Payable:
“CMS – UWA”
If by credit card. I authorise you to debit my credit card account
as follows:
___.___.___.___ ___.___.___.___ ___.___.___.___ ___.___.___.___
| NAME on CARD (PLEASE PRINT):_________________________________________________________________________ |
|
| ADDRESS:_______________________________________________________________________________ | |
| ADDRESS:_______________________________________________________________________________ | |
| POST/ZIP CODE: ___________________________________ | Expiry Date: ____/_____ |
| COUNTRY:_________________________________________ | FAX NO.: ______________________ |
| SIGNATURE:_______________________________________ | DATE: ________________________ |
Please mail your order and cheque to the address below. Alternatively, you can FAX the order and credit card payment details to:
*Orders cannot be processed until payment is madeCMS – UWA
Level 2, MRF Bldg
Royal Perth Hospital
Rear 50, Murray Street, Perth,
Western Australia 6000Fax: + 61 8 9224 0204