Name: __________________________ Home Phone # ________________________

Pager # (optional) _________________Other Contact # (optional)_________________

I would like to order: _____ 200 cards for $25.00 _____100 cards for $23.00

The address of the school and the main switchboard number will appear on the business card. In addition, which one(s) of the following would you like to have appear on your card?

_____ Class _____ Pager # _____ Home Phone # _____ Other

Which of the following titles would you like to have on your card? (Choose one)

_____ Student Doctor _____ Student Physician _____ Medical Student

_____ Graduate Student _____ PhD Student _____ Other __________________

Please fill out the above information and write your check in the right amount to ACHE/COHE.

Mail the Check and Order Form to:

The checks will not be cashed until the orders have gone to the print shop. Once the negatives are made, there will be no refund. We reserve the right to refund your money in the unlikely event that we cannot complete your order.