Subscription Form

Please print out this form on your printer, fill it out and mail it with your payment to the address
given at the end of the form.

Four issues (one year)

         Subscription rates:  
      (United States)  
         $95 for individuals & health care institution     
        $225 for corporations
         
      (U.S. possession & Canada) 
        $105 USd (individuals & health care institution) 
        $235 USd (corporations)
         
      (Other countries) 
        $115 USd (individuals & health care institution) 
        $245 USd (corporations)

  (Please Print)

Name: _______________________________________________________

Title: _________________________________________________________

Institution: _____________________________________________________

Address1: _____________________________________________________

Address2: _____________________________________________________

City: _____________________________ State: ______ Zip: _____________

Country: _____________________

Phone: ___________________________ Fax: _________________________

E-Mail: __________________________

We do not accept credit card orders. Payment (checks and money orders) should be made payable to:

ADVANCES IN EXPOSURE PREVENTION
PO Box 800764
University of Virginia
Charlottesville, VA 22908-0764

Phone: (434) 924-5159 o
Fax: (434) 982-0821
Email: epinet@virginia.edu