SPANISH FLU CONFERENCE : ORDER FORM FOR CONFERENCE PAPERS
(to be sent with payment to: Associate Professor Howard Phillips, Dept of History,
University of Cape Town, Private Bag, Rondebosch, 7700, South Africa,
or faxed to him at 27-21-6897581)
Your name.................................................................................
Your postal address...................................................................
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Your e-mail address and fax number............................................
Please send me the following conference papers (state name of author):
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The cost of each paper is $5 and postage for each batch of 10 papers
or fewer is $10. Payment must accompany this form and may be made by cheque
made out to `University of Cape Town' or by credit card (fill in below):
CREDIT CARD PAYMENT:
Please debit my credit card as follows: TOTAL PAYMENT $.........
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Diners Club..............
Card Number................................................. Expiry date...............
Card Holder's
name..........................................................................
Card Holder's
address......................................................................
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Card Holder's
signature........................................................................