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World CME Subscription Form
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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
11 Colston Avenue
Sherbrooke 3789
Victoria - AUSTRALIA
Fax: +61 3 9755 2266
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.
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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) :
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CME section
Video section
Individual subscription
Group subscription
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I am eligible for the Low Income nation free subscription: Yes No Check subscription rate/ perannum
Middle Income Nation subsidy; US$10
Full price; US$50
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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)
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Credit Card type: VISA
BANKCARD
MASTERCARD
Expiry Date:
Card Number:
Name on card:
Amount:
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Or bank transfer to: medi+WORLD International
ANZ
Glenferrie Branch
Account Number: 560254 6414 94039