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Paid Subscription Subscription Information: - 5 Issues per Year (Currently) - Subscription can begin anytime - Agency discounts at 10% - All International fees incl shipping - Subscription can be Cancelled

1 YEAR SUBSRIPTION United States - Back issues are available INTERNATIONAL & CANADA - 90 days Missing Claims SINGLE ISSUE United States INTERNATIONAL & CANADA

$99 $173 $20 $32

Fill Out Information Online then Print 1 Year Subscription OR 2 Year Subscription From ____________To_______________ Forward this form to:

Single Issue of the Magazine:

Vol: _________ Issue: _________ Number of Copies: __________

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Shipping Address: Name: _____________________________________________ Street: _____________________________________________ City: _______________________ State: _______ Zip: _____ Country: __________________________ Billing Address: Name: _____________________________________________ Street: _____________________________________________ City: _______________________ State: _______ Zip: _____ Country: __________________________ Payment Type: Check/Cheque (Attach to form) Card ______________________ Credit Verification#: ________ Master Expiration Date: ___ _____ Visa MM YYYY AmEx

Vendome Group PO Box 11404 Newark, NJ 07101-4014 For Credit Card Payment over the phone, please Contact: Mike Koplin Director of Operations Tel: 212-812-8980 For other processing email: [email protected] All confirmation will be emailed upon request.