Membership Information

Gift Order Form

  
Fill out this form and then print. Mail or fax the order form to:
The Society of Teachers of Family Medicine
11400 Tomahawk Creek Parkway, Ste.540
Leawood, KS, 66211
913-906-6000 · 800-274-2237, ext. 5404
Fax: 913-906-6096, mruhl@stfm.org
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Subtotal:
Click to calculate shipping (10% of order total) Shipping/Handling: 
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Bill To
Name:
Company:
Address1:
Address2:
City, State, Zip:
Phone:
E-mail address:
Enclosed is my check, made payable to STFM (US funds only).
Charge: MasterCard VISA American Express
Account Number:
Expires:

Signature: ________________________________________________________

Ship To
Name:
Company:
Address1:
Address2:
City, State, Zip:
Phone:
E-mail address:
Member Information