First Name:___________________ Last Name:_________________________ |
Phone:________________________ |
Address: _______________________________________________________ |
A CD containing handouts is included in both VHS and DVD formats.
Item |
Qty |
Cost per Unit |
Total |
VHS Tape |
|
$50 |
|
DVD |
|
$50 |
|
+
$5 (Shipping) |
= _________
**Unfortunately, we can only accept checks. Please make all checks payable to UCD.**
Please print and mail completed Form and Fee to:
UCD/Autism Research Group/Galit Mankin
4200 E. 9th Ave. C268-30
Denver, CO 80262
303-315-1748