Please print out this form and send it to us. You can also order by phone, fax or e-mail. Cheques should be made payable to The Upledger Institute UK.

PLEASE NOTE THAT THE FORM CANNOT BE USED TO ORDER ONLINE

UK carriage charges: Up to £20 = £3.00 / £20-£40 = £5.00 / £40-£50 = £6.50 / £50 or more = £8.00
Overseas: Europe add 30%, elsewhere add 100%

2 Marshall Place, Perth PH2 8AH Scotland
Tel: 01738 444404 Fax: 01738 442275 E-mail: mail@upledger.co.uk

Method of payment:   Cheque .......   Credit card .......   Other (please specify)....................

Visa [   ] Mastercard [   ] Delta [   ] Switch [   ] Electron [   ] Solo [   ]     

Card Security Code (all cards).............    Telephone Number.......................................

Name (as it appears on card) .....................................................................................    

Address (where card is registered) ..............................................................................    

................................................................................................Post Code ...............

Signature ......................................................................................................