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Mail to:

QUEST
Muscular Dystrophy Association
3300 E. Sunrise Drive
Tucson, AZ 85718-3208


____ check _____ money order (U.S. funds solamente)

____ 1 anno - $15 (U.S.)   ____ 1 anno - $24 (all'esterno of U.S.)
____ 2 anni - $24 (U.S.)
  ____ 2 anni - $37 (all'esterno of U.S.) - 20% savings
____ 3 anni - $32 (U.S.)   ____ 3 anni - $50 (all'esterno of U.S.) - 30% savings

Prices Effective gennaio 2009.


Name: ____________________________________________


Address: _________________________________________


City: __________________________ State: __________ Zip: _________________


Credit Card: ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___


Signature: ______________________________________ Exp. Date:___ ___ / ___ ___
(necessari per credit card orders)

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