Diabetes Education Connection www.diabeteseducationconnection.com Order Form - To Teach, To Learn, To Live: The Complete Diabetes Education Guide for Health Care Professionals, Second Edition (2006)

Name________________________________________________________________________ Address______________________________________________________________________ City__________________________ Prov./State___________ Postal/Zip Code ____________ Country__________________________ Telephone___________________________ Email____________________________________

* Please do not fill out but contact Diane at diane@diabeteseducationconnection.com or by calling 1-888-878-9600 for special pricing and shipping on orders of 5 or more books. * Number of Copies Price per Copy                             Total                                          X $58.00      Please add $10.00 Shipping for First Book                                       +     Please add $2.00 per Book Shipping for Each Additional Book                 +     Subtotal                                            +5% GST on Canadian Orders       +     Total Funds in Canadian Dollars

Send cheque or money order along with this form to: Healthy Self PO Box 1584 Vernon, BC, Canada V1T 8C2              Or to charge to your VISA or MasterCard, please call 1-888-878-9600, fax (250) 542-5919, or mail this form to Healthy Self. Name on card____________________________________________ Card Number____________________________________________ Expiry Date______/______/______ Signature________________________________________________ Total Charged to VISA/MasterCard _____________________ For questions regarding this order, please email me at diane@diabeteseducationconnection.com.