MATERIALS ORDER FORM FOR 25% ME GROUP

Text Box: PLEASE SEND ME THE FOLLOWING ITEMS FOR M.E. AWARENESS WEEK!
NAME:…………………………………………………………………………………..
ADDRESS:……………………………………………………………………………...………………………………………………………
POST CODE…………………….
TELEPHONE:…………………………E-MAIL:………………………………….…..
I/WE WILL BE USING THE ORDERED ITEMS TO SEND TO THE FOLLOWING PLACES:

WOULD YOU PLEASE SEND ME THE FOLLOWING ITEMS (INDICATED BELOW)

MATERIAL	NO. ITEMS PER PACK	EXAMPLE COST PER ITEM	QUANTITY	TOTAL COST
COMPLETE 2004 ME AWARENESS INFORMATION PACK	ONE	£1.50
GLOSSY ME PIC POSTER A4 size	ONE	£0.75
GLOSSY ME PIC POSTER A3 size	ONE	£1.50
SEVERELY AFFECTED POSTER – ‘WOULD YOU BE SURPRISED BY THIS COMPARISON?’	ONE	2X2^NDCLASS STAMPS*
REPORT FROM ‘ESSENTIAL SERVICES FOR SEVERELY AFFECTED’ QUESTIONNAIRE	ONE	4X2^NDCLASS STAMPS*
GROUP LEAFLET (PINK)	PER PACK OF 10	3x2^ND CLASS STAMP*
PATIENT PERSPECTIVE LEAFLET	PER PACK OF 10	3x2^ND CLASS STAMP*
M.E. INFORMATION SHEET	PER PACK OF 5	5x 2^nd CLASS STAMPS*
STANDARD COVERING LETTER FOR AWARENESS: GP’s, CAB’s, HOSPITALS ETC	PER PACK OF 5	2X2^NDCLASS STAMPS*
GIFT AID DECLARATION FORM	ONE	FREE
INFORMATION REGARDING MEMBERSHIP YES/NO
TOTAL COST
DONATION (Thank you)
TOTAL ENCLOSED**

* OR PAY FOR ITEMS WITH A CHEQUE ** PLEASE MAKE CHEQUE PAYABLE TO: ‘25% ME GROUP’

PLEASE RETURN FORM TO:

25%ME GROUP. 4 DOUGLAS COURT, BEACH ROAD,

TROON AYRSHIRE. KA10 6SQ.

Charity Number: SC034265