Tourette Syndrome In-Service Curriculum ORDER FORM Please check your applicable category below [ ] TSA-Affiliated Chapter, Support Group, or TSA Member.....$75.00 + $5.00 S/H = $80.00 [ ] School/Institution, Allied Professional, non-Member.....$150.00 + $5.00 S/H = $155.00 [ ] SAVE! Join TSA and receive The Educator's In-Service Program as a Member: [ ] Individual - $45.00 Membership Dues + $75.00 + $5.00 S/H = $125.00 [ ] Family/Allied Professional - $60.00 Membership Dues + $75.00 + $5.00 S/H + $140.00 For qualtity orders, call the TSA Publications Department at 718-224-2999 Name:___________________________________________ Affiliation:________________________________________ Address:_________________________________________ City:_____________________ State:________ Zip:________________ Check applicable payment method: [ ] Enclosed is a Check or Money Order made payable to Tourette Syndrome Association, Inc. Please charge the following credit card: [ ] MasterCard [ ] Visa [ ] American Express Card #:________________________________ Exp Date:___________________
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