Alzheimer Activities Service
Hope is the Power of Life & Fuel of Our Dreams







   

Printable Order Form - For Mail Orders Only
To place an order by mail, type in all the information below and print
(click the 'Print this Page' button) and mail this form with your payment
Name:  
Address:  
City:   State:   Zip:  
Phone Number:  
Email:  
Item Description Quantity Price Per Item S/H Total
Online Training Program $120.00 N/A
Training Video $14.95 $3.00
Activity Book $24.95 $5.00
Activity Kit (includes video) $49.95 $8.00
Custom Activity Workshop (Call for Schedule)
Additional Activity Items (Call for Details)
  Grand Total:
Method Of Payment:
American Express Visa M/C Check Money Order
Credit Card #:
Expiration Date: Signature: _________________________
(After printing this form below, Sign your name above)
AFTER you complete the information above Please Submit Payment & This Form To:

Alzheimer Activities Services
P.O. Box 250313
West Bloomfield, MI 48325


If payment by Check, Make Check payable to
“Alzheimer Activities Services”

(248) 360-7904 ~ aactivities@msn.com





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P.O. Box 250313 West Bloomfield, MI 48325 (248) 360-7904

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