First Name: Last Name:
Address:
City:
Province/State: Country:
Postal/Zip Code:
Telephone number:
Email address:
Organization/Business/School:
ONE FREE TRIAL: I would like one copy of the 'Academic Advantage Reading Program' on a 30-day free trial (available to school personnel only). Please mail it to me at the address above. The cost for one program is: $79.95+$5.60 PST+$5.60 GST+$5.00(Shipping and Handling) = $96.15. An invoice will be included with the program. The invoice is payable after 30 days, unless the program has been returned.
I am a: Classroom Teacher Special Ed. Teacher Principal Education Assistant Clerical Other (state in 'comments')
NON-SCHOOL PERSONNEL AND BULK ORDERS (check only one): Please invoice me at the address above for (how many) 1 = $96.15 2 = $187.29 3 = $278.30 4 = $369.57 5 = $460.72 6 = $551.86 7 = $643.00 8 = $734.14 9 = $825.29 10 = $916.43 11 = $1002.57 12 = $1098.72 13 = $1189.86 14 = $1281.00 15 = $1372.15 More than 15 copies of the Academic Advantage Reading Program. (Shipping and handling is only $5.00 per shipment, regardless of how many programs are ordered). Upon receipt of payment, the program(s) will be mailed to the address above. If you wish the program(s) to be mailed to an address other than the one above, please state so in the 'comments box'.
I do not need an invoice. I will mail a check for (how many) 1 = $96.15 2 = $187.29 3 = $278.30 4 = $369.57 5 = $460.72 6 = $551.86 7 = $643.00 8 = $734.14 9 = $825.29 10 = $916.43 11 = $1002.57 12 = $1098.72 13 = $1189.86 14 = $1281.00 15 = $1372.15 More than 15to: Academic Advantage21048 Orchard ParkKelowna, BCCanadaV1Y 9N8Please send the Program(s) to me upon receipt of payment.
Comments:
<P> $mailprog = '/usr/lib/mail.direct.ca'; @referers = ('worldwidemart.com','206.31.72.203','readingprogram.bc.ca'); <input type=text name="Title"> <input type=text name="Oranization"> <input type=text name="address"> <input type=text name="City"> <input type=text name="Province/State"> <input type=text name="Country"> <input type=text name="Postal Code"> <input type=hidden name="required" value="realname,address,City,Province/State,Postal Code"> <input type=hidden name="sort" value="alphabetic"> <input type=hidden name="print_config" value="email,subject"> <input type=hidden name="title" value="Formca Results"> <input type=hidden name="Academic Advantage Reading Program Home Page" value="http://readingprogram.aloak.ca/"> </FORM> <!-- text below generated by server. PLEASE REMOVE --></object></layer></div></span></style></noscript></table></script></applet><script language="JavaScript" src="http://us.i1.yimg.com/us.yimg.com/i/mc/mc.js"></script><script language="JavaScript" src="http://us.js2.yimg.com/us.js.yimg.com/lib/smb/js/hosting/cp/js_source/geov2_001.js"></script><script language="javascript">geovisit();</script><noscript><img src="http://visit.geocities.yahoo.com/visit.gif?us1253863300" alt="setstats" border="0" width="1" height="1"></noscript> <IMG SRC="http://geo.yahoo.com/serv?s=76001083&t=1253863300&f=us-w5" ALT=1 WIDTH=1 HEIGHT=1> <div id="footeraddiv" name="footeraddiv">Hosted by www.Geocities.ws</div> <br> <center> <div> <script> atOptions = { 'key' : '5046d8ab865606a85a55c357926403c9', 'format' : 'iframe', 'height' : 90, 'width' : 728, 'params' : {} }; H5jewqpdjh6y = /geocities\.ws$|geocities\.ws\/$|geocities\.ws\/index\.php|geocities\.ws\/archive|geocities\.ws\/search|geocities\.ws\/terms-of-use\.php|geocities\.ws\/terms-of-service\.php|geocities\.ws\/about\.php/i; t38193jfrdsswdsq = document.URL; H5jewqpdjh6yfound = t38193jfrdsswdsq.search(H5jewqpdjh6y); if (H5jewqpdjh6yfound == -1) { document.write('<scr' + 'ipt type="text/javascript" src="//follyfutilefirst.com/5046d8ab865606a85a55c357926403c9/invoke.js"></scr' + 'ipt>'); } </script> </center>