Order Form
Bert's Eye View
"Coping with Macular Degeneration"
Name 
___________________________________________________________
 
Address
___________________________________________________________
 
___________________________________________________________
 
Phone
___________________________________________________________
 
Method of payment:
______ Check or Money Order Enclosed
              (payable to the Iris Network)
 
______   Visa or Mastercard
               Card Number   _______________________
               Exp. Date         _______________________

 
Quantity    _____________
(cost per book $10.95)
 
Shipping / Tax $2.00
 
Total Enclosed
Price    _______________________
     
           
            _______________________
 
            _______________________
Mail payment and order to The Iris Network, Bert's Eye View,
189 Park Avenue, Portland, ME 04102  Inquiries - please call Terri at (207)774-6273
Net proceeds from sale of this book go towards the provision of Vision Rehabilitation service
to people who are visually impaired due to macular degeneration.
 
The Iris Network is a non-profit organization serving the visually impaired since 1905