International Order and Donation Form

Please print this page, fill it out and mail to the address below. 
 


Items
Quantity
Price
US Dollars

Totals

Windows to Ordinary Souls
_____
$19.95
$_________
Safe Passages:  Emergency Obstetrical Care in a Time of Aids
_____
$29.00
$_________
Circles of Life:  Integrating AIDS Prevention and Fertility Awareness
_____
$25.00
$_________
A New Robe:  Parish Nursing in AIDS Prevention and Care
_____
$25.00
$_________

Shipping Chart
based on subtotal of order
Subtotal               Amount
up to $10.00           $ 3.50
$10.01-$  25.00      $ 6.00
$25.01-$  50.00      $ 7.50
$50.01-$  75.00      $ 8.75
$75.01-$100.00      $ 9.50
over $100 ............9.5 %
Out of country orders: Canadians add an additional $5.00 All other countries add $10.00.  Please specify U.S. dollars on checks and money orders.

Subtotal:
$_________
Shipping (see chart to the left)
$_________
Send Newsletter
yes    no
I would like to make a tax-deductible contribution to Maternal Life International in the amount of:
$__________
Please include check or money order payable to:
Maternal Life International
GRAND TOTAL
$__________
 

Name ____________________________________
Street Address ____________________________
__________________________________________
City __________________ State ______________
Zip Code _______________
Country _________________________
Phone
(____) ____________________
Email _______________________
_____________

Send me your email updates  yes             no

Mail to: 

Maternal Life International
326 S. Jackson St.
Butte, Montana, USA 59701
Phone/FAX: (406) 782-1719
usacares@in-tch.com