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Blindskills, Inc.
P.O. Box 5181
Salem, OR 97304-0181
(800) 860-4224 or (503) 581-4224
info@blindskills.com

ORDER FORM

Name:___________________________________________________________

Organization: ________________________________________________

Street:________________________________________________________

City:______________________________ State:_____ Zip:____________

Country/Postal Code:___________________________

Telephone:___________________

E-mail: ________________

Visa, MasterCard, checks, and money orders are accepted. Make checks and money orders payable to Blindskills, Inc. Please indicate how many copies you would like to order of each format.

CONNIE'S KITCHEN (now on sale at $10 per copy) _______Braille ______ Large Print

WHERE DO I GO FROM HERE? (one free copy, additional copies $5 per set) ______CD

Enclosed amount: $ _________________

VISA/MC number:________________________________________ Exp. Date: __________

Authorized Signature: _______________________________________________________

Please send me a free sample issue of DIALOGUE. ___ YES ___ NO

Please indicate your preferred format.

_______Braille ______ Large Print _______ E-mail

IMPORTANT:

The following item is required by the United States Postal Service in order to document the FREE MATTER eligibility of our readers.

This publication is for the use of a person who is:

(Circle One) Legally Blind     Deaf/Blind     Sighted

Please correspond in: ___ Braille ___ Print