First name: Last name: Ms Mrs. Miss Dr. Mr.
Title: Organization: Street address: City: State or Prov: Postal code: Country: Phone: Fax: E-mail:
Book QuantityNumber of Books Ordered: at $22.95 per book. Total Cost $ (Add state sales tax) Total Sales Tax $ (Add $1.50 per book shipping) Total Shipping $ Order Total $
Women's Organizations taking part in the Special Benefits Program
will be billed at $13.75 per book. Minimum order of 5 books.)
Credit card (We will phone you for the number.) Enclosed check or money order (Make checks payable to The Launch Pad.) Special Benefits Program (Event Name):How should we contact you to respond to comments or for order confirmation?:
Thank you for your order.
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Mail-in orders should be sent to: The Launch Pad, 8311 Jackson Springs Rd., Tampa, FL 33615
Orders may be faxed in to 813-249-0105.