Health Administration Press (HAP) Subscription Order Form
(To complete this form, please fill in information, print, and submit to HAP as directed below)


Please select from the following:
Price:
Foreign Shipping?
Quantity:
Total:
Frontiers of Health Services Management $125.00
+ $10.00
Journal of Healthcare Management $125.00
+ $10.00
x
   
MD residents add 6% sales tax
 
Grand Total:

Method of Payment
Bill me (Fax with PO to (312) 424-0014)
Check (Please make payable to Health Administration Press)
Credit Card:
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Account Number: Exp. Date:
Cardholder Name:
       
       
Signature: ______________________________________________________
   
Date: ____________________

Shipping Information:
(Please attach separate pages for multiple subscriptions)
Name:
Title/Position:
Institution/Company:
Address:
City/State/Zip:
Country:
Phone Number:
Fax Number:
E-mail Address:

(If paying by credit card please be sure to sign and date before submitting.)
Mail, phone, or fax your order to:
The Foundation of the American College of Healthcare Executives, Subscription Services
1 N. Franklin St., Ste. 1700, Chicago, IL 60606-3529
Phone: (312) 424-9456 Fax: (312) 424-0014