Student Special Order Form - Code 3152

View Student Subscription Special information page

  1. Print out and complete this order form.
  2. Send it to us by one of the following methods:

    • Mail your payment in US funds with proof of student status and order form to:

      Midwifery Today
      PO Box 2672
      Eugene, OR 97402-0223 USA

    • Fax your order with Visa or MasterCard number and proof of student status and order form to:

      +1-541-344-1422

Check one:

1 year of Midwifery Today magazine (four issues)—

$39 US
$49 Canada
$59 Other International

Contact Information

Please print.

First Name
Last Name
Street Address / P.O. Box
City
State / Province / Region
ZIP / Postal Code
Country
Telephone
Fax
E-mail Address

Payment Information

How will you make your payment?

Please complete the following items if you are paying by Visa or MasterCard. All prices are in US dollars.

Account number 
Expiration date  [ month / year ] 
Name of cardholder  [ please print ] 
Billing address if different from above  [ please print ]
 
 		 
Billing phone and/or e-mail address  [ please print ] 
Signature