Mds Educational Resources Order Form

MDS EDUCATIONAL RESOURCES ORDER FORM

First Name ______Last Name ______

Title ______Affiliation/University ______

Address 1 ______Address 2 ______

City ______State ______Zip/Postal Code ______

Country ______Phone ______Email ______

Type of Practice ______

Please indicate the quantity you would like to receive of each item. If your order exceeds 2 lbs (.91 kg) then we will contact you to provide a form of payment for the shipping costs. There is no charge for our publications.

QTY / PATIENT PUBLICATIONS
MDS Foundation Newsletter (The MDS News)
The MDS Messenger E-News E-mail Address:
MDS Foundation Diary for Patients
What Does My Bone Marrow Do?
□ English
□ Dutch*
□ Italian*
□ Portuguese*
*These materials are available in bulk orders only (25 or more). Individual copies can be downloaded from our website at:

It Takes Time to Realize Your Goals
100 Questions and Answers About Myelodysplastic Syndromes
Building Blocks of Hope – A global MDS Foundation print and online patient advocacy initiative, providing a personalized educational program for the patient and caregiver to prepare, participate, and LIVE with MDS.
□ English
□ Complete Packet ____
□ Book 1 – Understanding MDS ____
□ Book 2 – Seeking Treatment ____
□ Book 3 – Quick Tips ____
□ Book 4 – Iron Overload ____
□ Book 5 –My MDS Plan ____
□ Book 6 – The MDS Foundation ____
□ Canadian – English*
□ Canadian – French*
□ German*
*These materials are available in bulk orders only (25 or more). Individual copies can be downloaded from our website at:

Over
QTY / PROFESSIONAL PUBLICATIONS
MDS Foundation Newsletter (The MDS News)
The MDS Messenger E-News E-mail Address:
Consensus on Iron Overload Reference Card
QTY / DONATIONS
For a donation of your choice □ MDS Awareness Pin □ MDS Pen □ MDS Wristband
□ MDS Business Card Magnet
QTY / VIDEO PROGRAMS
Subcutaneous Chemotherapy – Practical guidelines for clinical practice (DVD)
Healthy Body Healthy Mind – New Ways to Manage MDS (DVD)

Please return this form to:The MDS Foundation, Inc.

4573 South Broad Street, Suite 150

Yardville, NJ 08620

United States

USA: 1-800-MDS-0839, Outside the US: 609-298-1035; Fax: 609-298-0590

Email: ,