ORDER FORM

Ship To:

Name:
Address:
City, State, Zip:
E-Mail (if available):

ITEM  #    PRICE        COST     
Breast Cancer Survivors' Club by Lillie Shockney   $14.95 
 Subtotal 
One book  $3.00. More than one book  $5.00Shipping 
 TOTAL 



To order, please send completed form, or facsimile, and check or money order payable to MSDBC to:

MSDBC
c/o Charmayne Dierker, President
21710 Bayshore Road
Chestertown, Maryland 21620-4401
(410) 778-1982

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