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	ORDER FORM	PAINLESS PARKER A National Renegade's Fight to Make Advertising "Ethical" To order, please complete this form and send to: Dr. Arden G. Christen Dept. of Oral Biology Indiana Univeristy School of Detistry 11 West Michigan Street Indianapolis, Indiana 46202-5186 Tel: 317 274 3859 Please pay in advance (international Money Order or Check) in the amount of US$24.95 plus $3 postage per softcover book, and $1 postage per each additional book, Please allow 4 - 6 weeks for delivery U.S. currency only. Please do not send cash. Make checks payable to Dr. Arden G. Christen. Quantity of Order: _____________x US$ 24.95 per copy Amount of Order : US$ ________________________ Orderer: ________________________________________________________ ...................DR. Mr. Mrs. Miss. Ms. SHIP TO:________________________________________________________ Mailing Address__________________________________________________ Mailing Address__________________________________________________ City_________________________State______________Zip Code__________ Country_____________________________ Your Daytime Phone Number:________________________________________ FAX Number:_____________________________________________________ Payment Amount Enclosed — Money Order or Check: USD $ __________