World CME Subscription Form
Subscription
form (pdf 482 kb)
To
avoid the need to send your credit card details over the internet, this
form can be printed out for you to fax, or post to:
medi+WORLD International Pty Ltd
572 Burwood Road,
Hawthorn 3122
Victoria - AUSTRALIA
Fax: +61 (3) 9819 3269
Alternatively, you can email your details to:
admin@mediworld.com.au
NOTE: On placement of an order this form becomes a TAX INVOICE.
Please keep a copy for your records.
I would like to subscribe to
World CME for ONE YEAR.
Name:
Postal Address:
Country:
Post Code:
Contact Phone Number:
Email:
Date (dd/mm/yy) :
CME section
Video section
Individual subscription
Group subscription
I
am eligible for the Low Income nation free subscription: Yes
No
Check subscription rate/per
annum
Middle
Income Nation subsidy; US$10
Full price; US$50
Online access:
(a personal password will be issued to you by medi+WORLD International)
Access via set of 5 CD ROMs:
(incurs an additional US$12 surcharge for postage and handling)
Credit
Card type: VISA
BANKCARD
MASTERCARD
Expiry Date:
Card Number:
Name on card:
Amount:
Or bank transfer to: medi+WORLD International
National Australia Bank Limited
Account number: 083 004 45410 2204
Branch: 330 Collins St Branch Melbourne VICTORIA
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