Breast Cancer Genetics Network of Michigan

UNDERSTANDING CANCER & GENETICS
A Counseling Handbook & Interactive CD-ROM Order Form

Name: ________________________________________________________________________

Institution: _________________________________________________________________

Address: _____________________________________________________________________

City: ____________________________ State: ____________________ ZIP: __________

Telephone: _______________________ Fax: ______________________

e-mail: __________________________ (For Office Use Only: Invoice No. _________)

 


Item Description                   Price Each     Quantity        Charges

Understanding Cancer and Genetics
Book (English)                         $75.00 x __________  $____________

Understanding Cancer and Genetics
Book (Spanish)                         $75.00 x __________  $____________

Understanding Cancer and Genetics
CD-ROM (English)                       $50.00 x __________  $____________

Understanding Cancer and Genetics
Book and CD-ROM Package (English)     $100.00 x __________  $____________


                                                    TOTAL:  $____________


Please make all checks payable to The Regents of the University of Michigan

Mail your order form with payment to:


Breast Cancer Genetics Network of Michigan
Telephone: (734) 764-2248 Fax: (734) 647-1564