To phone in your reservation,
call Instruct-online at 319-626-3295
and give the following information:

Catalog Number : wpagbm1885-iol
Webplay Name : Cuts to Rual Health Care Providers - Strategies to maintain independence, expand services and thrive
Speaker : Blane Markley
Price : $150 for 2 week access

All the information below is required:
Organization's Name : ______________________________
Address : ____________________
City/State/Zip : ____________________
Contact Name : ____________________
E-mail address : ____________________
Phone Number : ____________________

___ Pay by Check (Payable to : Instruct-online)
___ Pay by PO (Payable to : Instruct-online)
          PO#____________________
___ Pay by Credit Card (Mastercard or Visa)
          Card Number____________________
          Name on Card____________________
          Expiration Date______
          Credit Card Verification Number (from back of card)______