Request Form

Order Form:

We offer application information for the following nominal fee:

US Funds
3 countries................$20
Each additional country....$4

You may send check, cash, or money order.

For immediate delivery, please make check or money order payable to: Dr. L. A. Bajkai.

(Business checks usually take 14 days to clear our bank).

Before PRINTING OUT this form, please select the countries where you would accept a position.

Now PRINT OUT this form and write in the information below:

I am ordering Application Information for:

Teaching    Nursing     (Please circle one)

Full Name:(PleasePrint)______________________________________________

Address:_____________________________________________________________

City:____________________________________________________State:______

Zip:___________________________________

Phone: (________)-_________-___________

E-mail:________________________________

If you would like to have your listings e-mailed to the above e-mail address, please put an

x here___

MAIL completed form with check, cash, or money order to:

Friends of World Teaching-Nursing
PO Box 574
Carlsbad CA 92018-0574

Your order will be sent within 24 hours via FIRST CLASS MAIL, or e-mailed.

Thank you for your order!






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