JASH Order Form

To order, call or write to:
ASAE
2950 Niles Road, St. Joseph, MI 49085-9659, USA
Phone: 616.429.0300 Fax: 616.429.3852

Please enter my 1995 subscription to the Journal of Agricultural Safety and Health.

	U.S.	Foreign
ASAE Member	$34.00	$34.00
Nonmember	$65.00	$71.50

[_] ASAE member	Member No. ____________
[_] Nonmember	[_] Send membership information

Name	_________________________________________________________
Company	_________________________________________________________
Address	_________________________________________________________
City	_________________________________________________________
State/Province	________________________	Zip/Postal Code:	___________
Country	_________________________________________________________

METHOD OF PAYMENT

[_] Check Payable to ASAE	[_] Bill me	[_] Bill Company	[_] P.O. # _________
[_] MasterCard	[_] Visa	[_] American Express	[_] Diner's Club
Credit Card Number	_____________________________________________________
Expiration Date	_____________________________________________________
Cardholder Name	_____________________________________________________
Signature	_____________________________________________________
Foreign payment must be made in U.S. currency drawn on a U.S. bank; by international money order or U.S. bank draft.

For Your Librarian

Attention Librarian/Department Head
I recommend that a subscription to the new ASAE publication, Journal of Agricultural Safety and Health, be purchased for our library.

Name	_________________________________________________________
Title	_________________________________________________________
Department	_________________________________________________________
Date	_________________________________________________________

---