# [[Sandia MEMS Short Course CD Order Form]{.underline}]{.smallcaps}

#### Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

#### Requester: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Company/Org:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

City: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
State: \_\_\_\_\_\_ ZIP: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Phone (\_\_\_\_)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ FAX
(\_\_\_\_)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Country(s) of Citizenship:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Payment Method\*:

\_\_\_\_\_\_Credit Card, Type:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> *(Visa, MC, or American Express only)*

####### Credit Card Number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Exp:\_\_\_\_\_\_\_\_\_\_\_

####### Name as it appears on card: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

####### Cardholders signature: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_Check\*\* (Payable to: Sandia National Laboratories)

######## Please enclose this form with payment

**\*\*Please note that personal checks will not be accepted. Cashier\'s
checks, money orders, and checks issued by commercial enterprises,
government agencies, public or private institutions and the like, are
accepted.**

\_\_\_\_\_\_Project & Task Number
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*(SNL internal customers)*

Project/Task Manager's Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+--------+---------------------------------------+---------+----------+
| ##     | ## **Item**                           | ## **   | **       |
| **Quan |                                       | Price** | Extended |
| tity** |                                       |         | Price**  |
+--------+---------------------------------------+---------+----------+
| ##     | ## San                                | ## \    |          |
|        | dia MEMS Introductory Short Course CD | $490.00 |          |
+--------+---------------------------------------+---------+----------+
| ##     | ## Sandia                             | \       |          |
|        |  MEMS Advanced Design Short Course CD | $490.00 |          |
+--------+---------------------------------------+---------+----------+
| ##     | ## Sa                                 | ### \   |          |
|        | ndia MEMS Reliability Short Course CD | $490.00 |          |
+--------+---------------------------------------+---------+----------+
| ##     | ## **Total**                          | ###     |          |
+--------+---------------------------------------+---------+----------+

**\*CDs will be shipped when the payment and order form have been
received by mail, and the payment has cleared. (We are required to
obtain forms with handwritten signatures, and we apologize that we are
not able to accept faxed orders.)**

##### Please mail form and payment to: Sandia National Laboratories

##### Attn: Sherrie L. Crawford, MS 1078

###### 1515 Eubank Blvd. SE, Bldg. 957

###### Albuquerque, NM 87123