Subscription Form

World Specialists Directory

(WSD)

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Check (X) selected service and complete the contact information below
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Summary Page:

____ List Summary Page in WSD Directory: $250/yr
____ Link Summary Page to the specialist's web site: $120
____ Develop a summary page for the specialist: $85

____ Link specialist's web site to WSD: $120/yr

____ Develop a web site for the specialist (fee per page): $160

CONTACT INFORMATION

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Organization

                                  
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Contact Name: First        M.I.         Last            Title  


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Number  Street  Suite # (P.O. Box)      City    State/ Zip Code 


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Area Code        Phone #        FAX #                 Mailing Date      


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Internet Web Site Address (URL) if available

Mail this this form with your payment to:

Doctors' Marketing Service
P.O. Box 748, Lake Forest, California 92630-0748, USA