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Order Form for LACTNET T-Shirts, Sweatshirts and Transfers


Name: Joan MacNeil
Address: 34 Cartier Crescent
City,  State: Lower Sackville, N.S.
Postal code/ZIP: B4C 3K7
Country: Canada
Phone number: (902) 865-4723
Fax Number: s/a
E-Mail address: [log in to unmask]

(For outside the USA ONLY)
VISA/MC number: Mastercard 5191 2125 0278 0900
VISA/MC expiration date (mo and yr):06/99
Full Name on VISA/MC card: Joan C.W. MacNeil

                   T-Shirt
# of T-shirts: 0
Size(s):
+ postage (for each item):


                   Sweatshirt
# of Sweatshirts:  1
Size(s):large = $15
+ postage (for each item): $4

                   Transfers
# of Transfers: 0
+ postage (for each item):

TOTAL AMOUNT OWED (In US$): $19 US


Thank you!

Joan MacNeil
RN, BScN, IBCLC
([log in to unmask])

*Affordable health care begins with breastfeeding*