BOOK ORDER FORM
Mail to:
Thames Valley Children's Centre
779 Base Line Road East, London, Ontario N6C 5Y6 Canada
Please complete the following information (please print or type).
NAME: _________________________________________________________
MAILING ADDRESS:_______________________________________________
CITY: _______________________________ PROVINCE/STATE: ________
POSTAL/ZIP CODE: _______________ COUNTRY: ____________________
TELEPHONE: ________________________ FAX: _____________________
Email ADDRESS: ________________________________________________
(For "Toilet Teaching"
and "Do Not Open") Shipping and Handling (per book)
Price per book $9.95 In Canada and USA $3.00
International Call
________________________________________________________________
"The Print Club" Shipping and Handling (per book)
Price per book $44.95 In Canada and USA $7.00
International Call
________________________________________________________________
"Disabilities, Dragons and
other Magical Discoveries" Shipping and Handling (per book)
Price per book $19.95 In Canada and USA $3.50
International Call
________________________________________________________________
Quantity Price Total
"Toilet Teaching Your Special Child" ________ x $9.95 ________
"Do Not Open Until Puberty" ________ x $9.95 ________
"The Print Club" ________ x $44.95 _______
"Disabilities, Dragons and ________ x $19.95 _______
other Magical Discoveries"
Subtotal ________
Shipping & Handling ________
5% G.S.T. (Canada Only) ________
TOTAL ENCLOSED ________
Please send payment, payable to Thames Valley Children's Centre, by cheque,
money order or bank draft, in Canadian funds only OR
VISA: ____________________________ MasterCard: _________________________________
Signature _____________________________________ Expiry Date ____________________
We are interested in knowing who uses these manuals.
Please complete the following (optional) and return with your order, THANK YOU!
Position:
___ Parent ___ Nurse ___ Teacher ___ Therapist ___ Other (please describe):
Your special interests:
___ Spinal Bifida ___ Cerebral Palsy ___ Muscular Dystrophy ___ Developmental Delay
___ Speech/language delays ___ Other (please describe):