Respiratory Therapists Week

October 23-29, 2011

Online Order Form

Materials are limited and will be shipped on a first-come, first-serve basis, we cannot guarantee availability.
Materials must be requested by September 23, 2011. Shipping charges will apply to orders submitted after that date. Shipping charges will be applied to international orders.

*Please fill out this form completely before submitting.
Please note that required fields appear in Red.

Name:

CSRT Registration Number:

Shipping Address - this section must be completed in order to receive your items.

Hospital/Organization:

Department:

Street:

City:

Province:

Postal Code:

Daytime Phone:

Fax:

E-mail:

RT Promotional Items
*Please only order what you believe you will need, as there is a limited quantity of items.

Please send the following quantities of:

ITEMS	QUANTITY REQUIRED	Max. Order Amount
Poster and Calendar - English No longer Available Poster and Calendar - French		3 max.
Pocket Calendar - English No longer Available Pocket Calendar - French		25 max.
Lanyards No longer Available		10 max.
RT Pins		10 max.
Magnetic Bookmarks - biligual		50 max.
Brochure - biligual		50 max.
Do you wish to receive a banner? No longer Available	Yes No