Order Form

Caring for Drug Exposed Infants
by Barbara Drennen

PRINT THIS FORM and MAIL TO:
PICC 328 4th Avenue S., Kent, WA 98198

Ship to / NAME:_________________________________________________________________

ADDRESS:_______________________________________________________________________

STATE _____________________________ ZIP__________________________

PHONE:___________________________________________

EMAIL:___________________________________________________________

DVD - $75.00 donation each
(orders of 2 or more, $50.00 each)

Quantity___________ (shipping included - US only)

$________________________

BOOK - $10.00 donation each

Quantity___________ (shipping included - US only)

$________________________

BOOKLET - $5.00 donation each Quantity___________ (shipping included - US only)

$_______________________

TOTAL ORDER $_________________________

(for international orders please call PICC at 253-852-5253 for rates)

PRINT THIS FORM and MAIL TO:
Pediatric Interim Care Center
328 4th Avenue South
Kent, WA 98032