WORKERS COMPENSATION DIRECTORY

Subscription  Form

How to Use This Form: Please enclose the following items:
  • Completed Subscription  Form
  • Payment (check only - no credit cards) is made payable to: Doctors Marketing Service.

    • FEES:
               You may take 50% discount on all fees if you meet the deadline March 30, 2002
               (Payment received at Doctors marketing Service)

    Preferred Category (Front Page - Side Bars):
    Link Your Web site to Workers Compensation Directory:  Amount $
      $600 per year  ($50/month)   $398 per six months
    Link Your Web site + Additional Information:
    (service description up to 50 words)    		 Amount $
      $900 per year  ($75/month)   $650 per six months
    List Your Practice Name, address & phone number:
     (if you don't have a Web Site)
      Include service description up to 50 words)    		 Amount $
      $900 per year ($75/month)   $650 per six months

    General Category:
    Link Your Web site to Workers Compensation Directory:  Amount $
      $120 per year ($10/month)   $89 per six months
    Link Your Web site + Additional Information:
    (service description up to 50 words)    		 Amount $
      $156 per year ($13/month)   $127 per six months
    List Your Practice Name, address & phone number:
     (if you don't have a Web Site)
      Include service description up to 50 words)    		 Amount $
      $156 per year ($13/month)   $127 per six months
    Front Page (side bar) Listing (Depends on availability):                         Amount $ 
      $1800 per year ($150/month)   $1260 per six months ($105/mo)

    Workers Compensation Specialists (Left side bar) Listing (Depends on availability:
               You may list/link your practice name under various specialties. For example: A chiropractor may list
                   his/her practice under "Therapists" category to further enhance the practice promotion for referrals.
                   This service is available only in combination with primary listing in any of the above categories.
                    Please check (X) all categories where you wish your practice listed/linked:
     
    Chiropractors Physicians Therapists
    Attorneys Clinics Hospitals
      Number of categories X $90/Category/year =  $


    Total Order:
    To avoid any delays in processing your order, kindly double check all selected categories and enter appropriate rates.
     
    Total Amount Paid: $            Check # 
    Mailing Date:

    ORDER INFORMATION:
     
    Name 
    Title
    Department 
    Institution
    Address 
    City  State/Zip Code: 
    Country
    Area Code Telephone number:  FAX number: 
    E.Mail Address
    URL (web site address)

    Please Print Completed Form And Mail It With Your Payment To:

    Doctors' Marketing Service
    P.O. Box 748
    Lake Forest, California 92630-0748
    (949) 472-3767
     

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