Federal Tax ID
# 20-1803239

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Federal Tax ID
# 20-1803239

Order Patient Symposium
DVDs


To get your one or more of our DVD sets when you contribute to our support at certain levels.

Fill in this form and  Submit it so we can send your DVD copy to you as soon as possible

After you have submitted this form you may select from several methods of payment:

  • Credit card through either
    • PayPal (you don’t need to be a member) or
    • Google Checkout (They don’t charge us a fee).
    • Call us to pay by credit card over the phone.
  • Send a check by mail.

 

 

Donor First Name

Donor Last Name

Donor’s Name:

Donor’s Phone:

Donor’s E-mail:


Make your selection by using the radio buttons below each selection:
 

Order
the 2007 DVD
(US Ship $20)

Order
the 2009 DVD
(US Ship $30)

Order
the 2011 DVD
(US Ship $50)

Order all 3 DVDs
(US Ship $95)

 

 

 

 

International Orders add US $10

International Orders add US $16

Check the Contact Me box (below)

IF:

  • You do not want to pay on line by credit card and want us to call you to take your credit card payment on the phone.  We will then arrange a time that we will call.
  • You wish to order a quantity of DVD sets.
  • Otherwise just leave the Don’t Contact Me box checked
     


 Contact Me
 

Don’t Contact Me

 

First Name

Last Name

    Ship to Name 

    Address 

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Country:

    Zip or Postal Code

 

PRINT A COPY OF THIS FORM FOR YOUR RECORDS and then Click the Submit Button below to send your order directly to us via the Internet

 

 

 

 

Copyright © 2012 - The Corneal Dystrophy Foundation.