Proceedings Order Form
Your Order
Number of copies _____ @ $20 each (US Funds) = Total ______
Number of orders to Canadian addresses _____ @ $28 each ($Cdn) = Total ______
Mailing Address
Ship to (name): _____________________ Address: _____________________ Province/State: _____________________ Country: _____________________	Institution: _____________________ City: _____________________ Postal/Zip Code: _____________________
Contact Information
Phone: _____________________ Phone (secondary): _____________________	Email Address: _____________________
Payment Method (check one)
___ Cheque/Money Order	For cheque or money order please print out this form, enclose cheque or money order and mail to the address provided below.
___ Prepaid Purchase Order	For prepaid purchase orders please print out this form, enclose purchase order and mail or fax to the address provided below.
___ MasterCard or ___ VISA	For VISA or MasterCard please print out this form, fill out the credit card section and mail or fax to the address provided below.
Credit card section PLEASE PRINT
Cardholder's Name: __________________ Expiry Date: __________________ Card Number: __________________	Authorizing Signature: __________________ Transaction Date: __________________
Mail this form to:	FLEAT III Proceedings c/o Language Centre P.O. Box 3045 University of Victoria Victoria, B.C. Canada V8W 3P4
Our fax number is:	(250) 721-8778
THANK YOU for your interest in FLEAT III Proceedings!