CREIGHTON MODEL FertilityCare™

LATIN AMERICA AFFILIATE PUBLICATIONS ORDER FORM (PD-5)
Name / Order Date
Phone / FCCA Center name
Fax / FCCACenter #
Email / Purchase Order#
BILL TO: / SHIP TO:
Name / Name
c/o / c/o
Address / Address
QUANTITY / ITEM / PACKAGE / PRICE / TOTAL
Spanish Charts / Each
Package of 25 / $1.50
$32.50
Spanish User Manuals / Each / $10.00
Spanish Introductory Session PowerPoint on CD / Each / $95.00
(Non-returnable item)
Spanish Spice Index Cards / Package of 25 / $13.50
Spanish Introductory Session Evaluation / Pad of 25 / $7.00
Spanish Follow-up Evaluation / Pad of 25 / $7.00
Spanish Teacher Evaluation / Pad of 25 / $7.00
Spanish Reproductive Category
Spec.Cycle Review / Pad of 25 / $7.00
FCCA Brochure (Spanish) / Each / $0.30
Follow-up Forms (English) / Each
Pack of 25 / $3.50
$81.25
Information Cards (English) / Package of 25 / $12.00
Organizer Sheets (English) / Pad of 25 / $5.50
1 Stamp Starter Pack / 11 sheets + bag / $2.50
Plain Red Stamp / Per sheet / $0.25
White Baby Stamps / Per sheet / $0.25
Plain Green Stamps / Per sheet / $0.25
Green Baby Stamps / Per sheet / $0.25
Plain Yellow Stamps / Per sheet / $0.25
Yellow Baby Stamps / Per sheet / $0.25
TOTAL FOR MATERIALS ORDERED

6/1/14smt Prices Subject to Change

IMPORTANT: Once completed, please submit order form for approval to Pope Paul VI Institute’s Publications Department by email at or by fax at (402) 390-9851. The final invoice will be mailed and/or emailed for payment. Shipping and handling and taxes, if applicable, will be added to the invoice. Order must be pre-paid by credit card or PayPal before shipment from the Mexico City distribution center.

CREIGHTON MODEL FertilityCare™ materials not listed on this order form must be ordered from the Pope Paul VI Institute publications department — popepaulvi.com/shop.

Pope Paul VI Institute  6901 Mercy Rd.  Omaha, NE 68106 
 P: (402) 505-8942  F: (402) 505-8908