ORDER FORM

GBS/CIDP Foundation International

Product List

Product

Cost

Qty

Total

The Overview for the Lay-Person*

$6.00 per book

 

 

A Handbook for Care Givers

$5.00 per book

 

 

Caring for a Child with GBS

$3.00 per book

 

 

GBS Acute Idiopathic Polyneuritis (brochure)

0.50 each

 

 

CIDP/Chronic Inflammatory Demyelinating Polyneuropathy (brochure)

0.50 each

 

 

Pillbox

0.50 each

 

 

Communication Cards, 43 flip-over pages, Doctor, Nurse, Personal indexes

$20.00 per set

 

$

Magnets (while supplies last)

$2.00

 

$

“Climbing to Recovery”  DVD or VHS

$10.00

 

$

“CIDP” DVD

$10.00

 

$

Stationary (while supplies last)

$5.00

 

$

T-Shirts – Sizes ( L  *  XL) (while supplies last)

$5.00

 

$

Cookbook Volume II

$7.00

 

$ 

GBS/CIDP Piggy Bank (Special Shipping $2.00)

$5.00

 

$ 

 Subtotal

$


Shipping & Handling (U.S. ONLY)
Up to $5.00 = FREE
$6.00 - $15.00 = $3.00
Over $16.00 = $4.95
International orders please contact National Office for pricing
Rush/Overnight Delivery please contact National Office for pricing
                                               

                                                                                  

 

TOTAL $_________

 

To members living outside the U.S. – ALL TRANSACTIONS MUST BE MADE IN U.S CURRENCY.  All orders are PRE-PAID.

 

 

First Name                                                                                            Last Name

 

 

Mailing Address (include business name if mailing to business address)

 

 

 

 

City/State/Country                                                                             Daytime Telephone Number

 

               -               -               -                                                                      /       /                                                                              

VISA/MC/DISCOVER (Card Number)                                           Expiration Date

 

 

Cardholder’s Signature

 

GBS/CIDP Foundation International

The Holly Building

104 ½ Forrest Ave

Narberth, PA 19072

610-667-0131/(toll free) 1-866-224-3301

e-mail: info@gbs-cidp.org