> SYNERJY Directory ORDER FORM

Now you can order SYNERJY by credit card, by check or -- if you're an institution in the U.S. or Canada -- choose the billing option.

• To use your credit card, complete the form below. Then either click the Submit button to forward it to us via a secure link, or print and mail it.

• To pay by check, complete the form below, print and mail it to SYNERY with your check.

• To choose the billing option (institutions in the U.S. and Canada only), complete the form below:
Print and mail it to SYNERJY   or
E-mail it to us by doing the following:
   - Highlight the completed order form, then click on Edit/Copy.
   - Click on the e-mail option at the bottom of this form,
     Edit/Paste a copy onto the message, and send it to us.

Mailing address:
SYNERJY, PO Box 1854/Cathedral Station, New York, NY 10025.

Shipping Information:
First Name Last Name
Title
Organization
Address 1
Address 2
City   State Zip Code
Country
Telephone e-mail

Order Information:  SYNERJY Directory (print only)
Standing order @ $60/year (institutions)
One-year subscription @ $65 (institutions); $30 (individuals, pre-paid only)
Single copies of current issue @ $40 (institutions); $20 (individuals, pre-paid only)

(Outside US & Canada please add $6 per order for air mail postage.

Payment Information:
Please bill me for $ + $3 handling charge.
      (billing option is for institutions in the U.S. and Canada only)
 Visa
MasterCard
Credit card # Expiration date:

(If ordering by mail)
Signature:____________________________________

Enclosed is $ __________ (US$ only please; make check or money order payable to SYNERJY).
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