"Getting Ready to Test" Publications Order Form

Use this form when placing orders by fax or by mail. Directions are found at the end of the order
sheet.  Simply use the print button on your browser to print this form. (form date 11/1/05)

Step 1 -- Select the "Getting Ready to Test" materials you wish to purchase 

______ Item #W401 - The Written Examination
                                      Cost: $52 plus $8 shipping/handling (Priority Mail) - $60 total

______ Item #Q402 - The Oral Examination
                                     Cost: $52  plus $8 shipping/handling (Priority Mail) - $60 total

______ Item #CS405 - A Review and Preparation Manual for the Written
                                     Clinical Supervisor Examination
                                     Cost: $79 plus $6 shipping/handling (Priority Mail) - $85 total

______ Item #PV406 - A Review and Preparation Manual for the Written
                                     Prevention Specialist Examination
                                     Cost: $79 plus $6 shipping/handling (Priority Mail) - $85 total

______ Item #M404 - A Review and Preparation Manual for Drug
                                     and Alcohol Credentialing Examinations
                                    [  ] Cost: $149 plus $12 shipping/handling (FedEx Ground Shipment) - $161 total

                                    [  ] Cost: $149 plus $15 shipping/handling (USPS Priority Shipment) - $164 total

Step 2 -- Personal and Payment Information
Be sure to enter all information requested.  PLEASE PRINT

Complete Name: ________________________________________________________

Address: ________________________ City: ______________ State: ____ Zip: ______

E-mail address: ___________________________Daytime Phone Number: __________
(We will send confirmation by e-mail when your order is shipped)

Payment method:  Check_____  Money Order _____ 

                            Credit Card: [  ] VISA    [  ] MasterCard

                                               [  ] American Express    [  ] Discover

                     Card Number: _____________________________________

                     Expiration Date: ________ / ________
                                               (month)           (year)

Order Total: ______________________

Step 3 -- Mail this form with payment (check, money order, credit card information) to: 
                        Distance Learning Center, LLC
                        P.O. Box 29195
                        Santa Fe, NM  87592

     Or fax this form with credit card information to: (801) 991-7081