Order Form For CIDI-Auto

Please Print This Form And Send It And Payment To The Address Below

The program lists the title, name and institution (or address) of the licensee being the person responsible for confidentiality.

Licensee (Title, Name and Institution or Address (80 characters):

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Cost
New licensees: AUD$770 (includes GST)

Payment can be made by cheque or credit card

Cheques to be made payable to
WHO Collaborating Centre

Return cheque and order form to
WHO Collaborating Centre, 299 Forbes Street, Darlinghurst, NSW, 2010, Australia

Credit card details (Visa or Mastercard only)

Type of card

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Name on card

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Card Number

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Expiry date

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For further details regarding ordering the CIDI, please Contact Us: