ORDER FORM

In a Strange Land...People with Dementia and the Local Church

Please print and complete
(Orders may also be emailed to 4mpublications@tiscali.co.uk)

Name: ..............................................................................

Address: ........................................................................................

.................................................................................................

Post Code: ....................................     Contact Phone No: ...........................................

Signature: .................................................................

For every book sold, a donation will be given to the Dementia Services Development Centre at Stirling

    Quantity Total
IN A STRANGE LAND £10.00     £
Post & Packing      Free ----------- Free
TOTAL DUE ----------- -----------   £

I enclose a cheque in £ Sterling payable to: 4M Publications
send to :-   4M Publications, 82 Woodfield Park, Colinton, Edinburgh EH13 0RB
 Or, please send an invoice to the address above.       [    ]   

To be invoiced to pay by credit card (via PayPal) please insert your email address below; we will process your order accordingly

Email Address: ................................................................

FOR OFFICE USE
Date Order Received:
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Chq Recd/Invoice Sent/Credit card:
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