AzAMFT PUBLICITY BROCHURE ORDER FORM

Yes, I would like to order copies of the AzAMFT brochure. I understand that each bundle
of 20 brochures is priced at the rate of $5.00 per bundle. I have enclosed a check made payable to AzAMFT.

Name:

Address:

City: State: ZIP:

Number of Bundles Requested: (Bundle = 20 brochures)

Amount Enclosed: ( $5.00 / bundle)

Submit this completed form along with your payment to:

Frances Bernfeld, M.Ed., LMFT
P.O. Box 65224
Tucson, Arizona 85718

THANK YOU!