FAX ORDER FORM

Instructions

1. Print order form

2. Fill out form and fax to 208-361-6172

NAME_____________________________________________

ADDRESS_______________________________________________

CITY/STATE/ZIP__________________________________________

PHONE #__________________________________________

SS#_______________________________

*LICENSE INFORMATION*

STATE_______ LIC#_______________________

ARRT#__________ASRT#______________

PAYMENT INFORMATION

Please Circle

VISA - MASTER CARD - DISCOVER

CARD #_____________________________ EXP. DATE_________________

CARD HOLDER SIGNATURE___________________________________________

COURSE TITLE

# of
CREDITS

PRICE

QTY ORDERED

Radiation Protection In Medical Radiography

15

$83.00
 #

Better X-ray Interpretation

12

$79.00
 #

Trauma And Mobile Radiography

12

$69.00
 #

Quality Management In The Imaging Sciences

12

$83.00
 #

Radiographic Pathology For Technologists

12

$79.00
 #

Understanding Human Structure And Function

15

$85.00
 #

Patient Care In Radiography

12

$79.00
 #

Diseases Of The Human Body

18

$99.00
 #

Fundamentals Orthopedic Radiology

15

$93.00
 #

Radiographic Imaging and Exposure

13

$79.00
 #

SHIPPING INFORMATION

SubTotal
 $

SHIPPING & HANDLING
FREE

ORDER TOTAL
$

THANK YOU for your order!