If you would like to receive a copy of any of the publications listed below, please print this form and mail it with your payment to:
American Health Assistance Foundation
22512 Gateway Center Drive
Clarksburg, Maryland 20871
You may request a total of 10 free publications. There is a 50 cent charge for each additional publication with a minimum charge of $5.00.
You may request one free Annual Report. Each additional Annual Report is $5.00.
Postage and handling fees are also applied for orders coming from outside of the United States. Please email your name, address, and your publication selection(s) to Mr. Jeff Honaker at jhonaker@ahaf.org. You may also call (301) 948-3244. He will respond back with detailed instructions.
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| Publications |
Qty. |
Cost |
|---|---|---|
| Amsler Grid - Free | ||
| Living with Macular Degeneration - $5.00 | ||
| Low Vision Aid Resource List - Free | ||
| Macular Degeneration Research News - Free Newsletter | ||
| Macular Degeneration: The Essential Facts - Free | ||
| Safety and the Older Driver - Free | ||
| Subtotal |
| Qty. |
Cost |
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Method of Payment: |
Check | Money Order | Visa |
| MasterCard | AMEX | ||
When using MasterCard or
Visa, there is a $5.00 minimum purchase. |
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Credit Card Account Number: |
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Name as it appears on the card: |
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Expiration Date: |
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Signature: |
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