Ménière’s Support Group of NSW Inc.

Order Form for Ménière’s Disease Resource Items

(Please print and send to address given below, with payment)

 

Item

Number

Description

Quantity

Price (GST included)

Total

Item 1

SET OF BROCHURES

 

$  7.50

 

Item 2

AUDIO TAPE OF FIRST 8 BROCHURES

 

$ 10.00

(Members $ 5.00)

 

Item 3

VIDEO – Dizzy Terror

Do you want a captioned version? . . . . . . . . . . . . . . .

 

$ 35.00

(Members $ 25.00)

 

Item 4

AUDIO TAPE – Ménière’s & Allergies

 

$ 10.00

 

Item 5

BOOK ‘Understanding Ménière’s Disease’

 

$ 20.00

 

Item 6

Information Sheet on SERC

 

$   2.00

 

Item 7

Information Sheet on STUGERON

 

$   2.00

 

Item 8

Information Sheet on UREA

 

$   2.00

 

Item 9

Info Sheet on ENDOLYMPHATIC SAC REMOVAL

 

$   2.00

 

Item 10

Information Sheet on GENTAMICIN TREATMENT

 

$   2.00

 

Item 11

Information Sheet on BPPV

 

$   2.00

 

Item 12

AUDIO TAPE - Talks at the 2002 AGM

 

$ 10.00

 

Item 13

BOOK ‘Salt Matters – the Killer Condiment

 

$ 25.00

 

 

Donation to Ménière’s Support Group of NSW Inc.*

 

 

 

 

*  Tax deductible under Australian tax legislation.

 

TOTAL  =

 

 

Post or fax this form to: Meniere’s Support Group of NSW, P.O. Box 2134, Bowral NSW 2576  (Fax: 02 4861 2300)

Payment Amount:  $                            o Cheque        o Money Order       o Bankcard        o MasterCard         o Visa

Number:   ___ ___ ___ ___   ___ ___ ___ ___   ___ ___ ___ ___   ___ ___ ___ ___  Expiry date:  ___  / ___

Name on Card (please print):                                                                                   Signature:

Deliver to (name & postal address):     _______________________________________________________________

                                                                     _______________________________________________________________

                                                                     _______________________________________________________________

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No menu? Click on this link to go to our home page:  http://www.menieresnsw.org.au/