keyglobeiollogoPhone (319) 626-2302

To mail in your reservation,
print off this page, fill in the blanks
and mail to :

Instruct-online
955 Forevergreen Rd
North Liberty, IA 52317

Catalog Number : wpngd1773-iol
Webplay Name : CMS CoP New Revised Standards for Hospitals: IV, IV Medication and Blood Transfusion Guidelines
Speaker : Sue Dill
Price : $225 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)______