EL PASO COUNTY MEDICAL SOCIETY
2007 PICTORIAL DIRECTORY
. . . ORDER FORM . . .

The EPCMS pictorial physicians directories are limited, order early

The directory is a resource book for anyone needing information about the delivery of health care in our community. Includes physicians listed by name, specialty and company affiliation. Many helpful numbers.

PRINT this form, then:

MAIL to: EPCMS, 730 Citadel Drive East, #206, Colorado Springs, CO 80909, or

COME to the office to order (Citadel Shopping Center) and say hello!

Members = $15.00      Non-Members = $30.00        25 or more = $18.00

Add: $4.00 postage & handling for the first directory ordered

Add: $1.00 postage & handling for each additional directory (up to 3).

Four or more directories must be picked up at the society office.

Payment must be received in our office before your order can be mailed.

Please print name, address and telephone number below:

Name:__________________________________________________________________

Address:________________________________________________________________

City:___________________________________State:__________Zip:______________

Phone:_____________________________

Number of Directory(s) ordered: _______________ @ $________________

Plus Postage Amount: $ ______________

Total Due = $_______________