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Contact Details:
Mr.Mrs.Ms. __________________________________________________________________ Company ____________________________________ Title ______________________ Address __________________________________________________________________ City ____________________________________ State/Province _____________ Country ____________________________________ Postal/Zip Code ____________ Phone ____________________________________ FAX ________________________ Email ID __________________________________________________________________ Number of CD-ROMs ($150 per CD-ROM) ________________________________________ Payment by: [ ] Enclosed check in U.S. dollars (Make payable to Kovsky Conference Productions Inc.) [ ]American Express [ ]Discover [ ]Diners Club/Carte Blanche [ ]MasterCard [ ]VISA Card Number ________________________________________ Exp. Date ___________ Cardholder Name ____________________________________________________________ Authorized Signature _______________________________________________________ Billing Address ____________________________________________________________
Kovsky Conference Productions Inc. P.O. Box 1461 Monument, CO 80132-1461 719-481-8069 FAX 719-481-3389 Voice (credit card orders only)