Mail Order Form for Vaccination Liberation


Name:______________________________________________

Address 1:_________________________________________

Address 2:_________________________________________

City:_______________________________, State/Province:______________

Country:___________________________, Zip/Postal Code:_____________

Quantity	Item Description	              Unit Price  Total

_______|_____________________________________________|__________|_________

_______|_____________________________________________|__________|_________

_______|_____________________________________________|__________|_________

_______|_____________________________________________|__________|_________

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Full or above (not Basic) Members may take      Product Total: ___________
a 20% discount on Books, DVDs, bumper      	- Discount:    ___________
stickers, CDs but not Archive I+II CD, 		 Sub-Total:    ___________
pads, posters, or postcards.   			* Shipping:    ___________									   		                Sub-Total + Shipping  = Total: ___________ 

*Shipping: 1 item	2 items	  3 items  4 items   5 items 	6 items or more
USA	   $ 5	        $ 6	  $ 7	   $ 8	     $ 9	$10
Canada	   $10		$12	  $14	   $16	     $18	$20
Mexico	   $10		$12	  $14	   $16	     $18	$20
All others $15		$18	  $21	   $24	     $27	$30
     
           *Note: There is no shipping charge on donations, 
membership and bumper stickers or static cling stickers. 
Shipping is included in price of bundles of Artificially 
Sweetened Times, bundles of postcards and Archive I+II.            
Please send your check, or money order to:
Vaccination Liberation
P.O. Box 457
Spirit Lake, Idaho 83869-0457