Home  / Old CORD Site  / NTPN  / Opening Session DVD order form

Your first copy is free. Each additional copy will be $5.

Please print this page, complete, and fax or mail to Janice Marie Ferguson. (jferguson@cord.org e-mail or 254-800-518-1410 ext. 253 phone)

Fax:
254-776-2306 

Mail:
NTPN
601 Lake Air Dr.
Waco, TX  76710

Name:_________________________________________________________________

Organization:____________________________________________________________

Address:_______________________________________________________________

City:____________________ State: __________ Zip:___________________________

Phone:________________________________________________________________

E-mail:________________________________________________________________

Quantity of DVDs:________________ 

Total:$__________

Method of Payment:
(Only if ordering more than one copy)

___CHECK #___________________

___PURCHASE ORDER #___________________

___CREDIT CARD: Circle one  VISA     MASTERCARD   AMERICAN EXPRESS

CARD #_______________________________________________________________

Expiration:___________ Signature: _________________________________________

Billing Organization:______________________________________________________

Billing Address:_________________________________________________________

City:___________________ State:____________ Zip: _________________________

Billing Phone:___________________________________________________________