SCYA Protocol Guidelines Order Form

Date: ___________

Quantity Ordered: _______ @ $11.00 each

6 or more Ordered: _______ @ $8.00 each

Total amount enclosed: _________

Name:___________________________________________________________
Address:___________________________________________________________
City:________________________________ State: _____ ZIP: ____________


Make check payable to SCYA.

Mail to:
SCYA SERVICE CENTER
5855 Naples Plaza, Suite 211
Long Beach, CA 90803-5080

Phone: (562) 433-7426
FAX: (562) 438-8656
E-Mail: service@scya.org