Publication Order Form

If you would like to receive a copy of any of the publications listed below, please enter the information,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.

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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Alzheimer's Disease Publications
Publications	Qty.	Cost
Alzheimer's Research Review - Free Newsletter
Care for the Caregiver: Managing Stress - Free
Family Caregiver Health Guide - $2.50
Honest Answers for the Recently Diagnosed Alzheimer Patient - $2.00
I'll Be There: Caring For Your Parents, Job, Kids and Marriage - $1.00
Safety and the Older Driver - Free
Staying Safe: Wandering & the Alzheimer's Patient -Free
Through Tara's Eyes: Helping Children Cope with Alzheimer's Disease - Free
Understanding Alzheimer's Disease Brochure - Free
Subtotal

Macular Degeneration Publications
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

Glaucoma Publications
Publications	Qty.	Cost
The Essential Facts on Glaucoma - Free
National Glaucoma Research Report - Free
Living with Glaucoma - $5.00
Low Vision Aid Resource List - Free
Safety and the Older Driver - Free
Subtotal

Annual Report
Publication	Qty.	Cost
Annual Report - One free copy is available upon request

Grand Total

Qty.	Cost

Billing Information
When using MasterCard, American Express or Visa, there is a $5.00 minimum purchase.
Your Name:
Street Address:
City, State and Zip:
Telephone Number:
Total Amount Enclosed:
Method of Payment:	Check	[ ]
	Money Order	[ ]
	Visa	[ ]
	MasterCard	[ ]
	American Express	[ ]
Credit Card Account Number:
Name as it appears on the card:
Expiration Date:
Signature:
Date:

Please make checks payable to the American Health Assistance Foundation.

Publications Order Form

Grand Total