To Order a Copy of:
AUTISM: Out of the Darkness: Other Avenues
(Prgm #2)

Cost for this program:
$24.95
__3.00 (shipping)
$27.95 TOTAL

KVCR-TV
701 S. Mt. Vernon Av
San Bernardino, CA 92410

(If you choose to Fax (909) 885-2116)

______________________________________________________________
Name

______________________________________________________________

______________________________________________________________
Address

______________________________________________________________
Phone

______________________________________________________________
E-Mail

If you would like to use a credit card, please complete the information requested below: KVCR accepts: (circle one) American Express, Master Card, VISA, Discover

______________________________________________________________
Credit Card Number

______________________________________________________________
Expiration Date

-- And/ Or --

To Order a Copy of:
AUTISM: Out of the Darkness
(Prgm #1)

Cost for this program:
$19.95
__3.00 (shipping)
$24.95 TOTAL

KVCR-TV
701 S. Mt. Vernon Av
San Bernardino, CA 92410

(If you choose to Fax (909) 885-2116)

______________________________________________________________
Name

______________________________________________________________

______________________________________________________________
Address

______________________________________________________________
Phone

______________________________________________________________
E-Mail

If you would like to use a credit card, please complete the information requested below:  KVCR accepts: (circle one) American Express, Master Card, VISA, Discover

______________________________________________________________
Credit Card Number

______________________________________________________________
Expiration Date