FASCETS Order Form

Written Material: Fetal Alcohol Spectrum Disorders, A Collection of Information for Parents and Professionals, by Diane Malbin, MSW 183 Pages, Second Edition, Illustrated, revised 2006	Quantity ______ @	$25.00	Price ______
Trying Differently Rather Than Harder, by Diane Malbin, MSW 80 pages, Second Edition, Illustrated, revised 2002 (Quantity Discount for “Trying Differently”, 1-49 copies - $15.00 each, 50-99 copies - $12.50 each, 100 copies & over - $10.00 each)	_______@	$15.00	_____
Training DVD: Fetal Alcohol and Other Drug Effects – A Four-Part Training Series for Parents and Professionals Part 1 -- Diagnostic Criteria: Effects of Prenatal Exposure Part 2 -- Common Learning and Behavioral Characteristics Part 3 -- Behaviors and Overlapping Diagnoses Part 4 -- Barriers to Identification: Historical, Cultural, Professional and Personal Price for parents, caregivers (Sliding fee scale available on request) Price for professionals, organizations	_______@ _______@	$150.00 $200.00	______ ______
Shipping/Handling: U.S. -- $4.00 per order plus per item charge: $2.00 for each copy of “Fetal Alcohol Spectrum Disorders: A Collection of Information for Parents and Professionals,” $1.00 for each copy of “Trying Differently Rather Than Harder” and $1.00 for each DVD Canada -- $5.00 per order plus per item charge: $2.00 for each copy of “Fetal Alcohol Spectrum Disorders: A Collection of Information for Parents and Professionals,” $1.00 for each copy of “Trying Differently Rather Than Harder” and $1.00 for each DVD International -- $5.00 per order plus per item charge: $3.00 for each copy of “Fetal Alcohol Spectrum Disorders: A Collection of Information for Parents and Professionals,” $2.00 for each copy of “Trying Differently Rather Than Harder” and Plus Shipping/ Handling: $2.00 for each DVD			$______
TOTAL		U.S. *	$_______
Send order form and check or bank draft to: FASCETS PO Box 83175 Portland, OR 97283 *** For Canada and other foreign countries, if possible please pay with a bank draft, with U.S. funds * Ship to:** Name_______________________________________________________________ Organization__________________________________________________________ Address_____________________________________________________________ City_______________________________State/Province______________________ Zip/Postal Code______________Country____________Phone__________________ Please add my email for FASCETS updates:__________________________________

Thank you. Please allow two to four weeks for delivery.

Phone/fax: 503-621-1271 Email: dmalbin@fascets.org Website: www.fascets.org

* Prices are in US dollars. Price breaks for quantity orders. Information on our sliding fee scale is available on request.