Subscription Form
Advances In Physical Medicine & Rehabilitation Directory

How to use this Form:
Use one Form per organization. To reduce "Banner", click on its "UPPER" right arrow. Click on "X" to close it.
Type in the Form, on screen response, (fill out all applicable blanks). 
Press "TAB" to move between blank spaces. When finished, please print the Form.
Preferred payment: Check drawn on an American bank.
Acceptable payment: International Money Order or a check drawn on a local bank by using your country's currency.
Our bank will send the check back to country of origin for collection. The process usually takes about 3-4 weeks.
Important Note:  Web pages sponsorship is based on availability. Longer advertisement period assure retention of selected care providers' web pages.
To sponsor web pages for specific care providers, please include a list of their names and addresses to remove them from availability to other companies.
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Special Rates (Contact Doctors Marketing Service) Regular Rates
Web Pages Sponsorship:
Exclusive Front page position on selected number of web pages ($12/year/Web Page)
Minimum Order, a sponsorship of 50 Web Pages: $600
Number of Sponsored Care Providers' Web Pages:
Multiply Number of Sponsored Web Pages X $12/Year = $		 Web Pages Sponsorship:
Exclusive Front page position on selected number of web pages ($25/year/Web Page)
Minimum Order, a sponsorship of 50 Web Pages: $1,250
Number of Sponsored Care Providers' Web Pages
Multiply Number of Sponsored Web Pages X $25/Year = $
Standard Subscription: LINK Your Web site to directory:
$60 per year ($5/month)		 Standard Listing: LINK Your Web site to directory:
$375 per year 
Link Web site + Description (Up to 100 words):
$90 per year ($7.50/month) 		 Link Web site + Description  (Up to 100 words) :
$456 per year 
List web site at Preferred Category:
     Front Page-directory: 
$600 per year ($50/month) 		 List web site at Preferred Category:
     Front Page-directory: 
$1200 per year
Multiple Category Listing:
Attach a side sheet of paper with a list of selected categories. To avoid listing delays, please make sure that your payment does match the number of selected categories.

TOTAL Fee: Add amounts from selected boxes above and enter here $ 
Date. Check Number.

ORDER INFORMATION:
Name 
Title
Department 
Company/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, USA
(949) 472-3767

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