Order Form

To have each FREE quarterly issue mailed to you, complete name and address, print out and mail to:

Lifeline Anxiety Disorder Newsletter, 431 Victoria Street, Shelburne, Ontario L0N 1S4, Canada.

Please enclose cheque or money order as follows:

$5.00 for postage and handling of 4 issues for delivery to Canadian addresses.
$5.00 US for delivery to US addresses.
$10.50 CDN, $8.00 US or £5.00 for delivery to all other addresses.

Name:  

Address:  

City:  

Province/State:  

Zip/Postal Code:  

Country:  

If multiple copies are required, for distribution from clinics, doctors' offices, libraries, mental health centres, etc., please complete the following box.

# Copies required: