Breaking The Silence - Order Form

Print and send with check or money order to:
NAMI Queens/ Nassau
1981 Marcus Avenue, Suite C-117
Lake Success, NY 11042

Name _________________________________________________________

School/ Organization _____________________________________________

Address _______________________________________________________

City ___________________________________________________________

State ____________________

Zip ______________________

E-mail ___________________

Phone ___________________

Check material being ordered:

Upper Elementary- includes "Brains Can Get Sick" poster
quantity _____

Middle School- includes the "Brain Game" board game
quantity _____

High School- includes "Warning Signs" poster
quantity _____

Individual lesson plans: $15.00 ea. S&H: $3, each additional add $1.50/ packet
Complete Set (Elem., Middle & HS) $40 ea. S&H $5, each additional add $2.50/ set
Please phone for cost of shipping large orders

# Individual packets x $15.00 =	$___________
+ shipping & handling: $3, each additional add $1.50/ packet	$___________
# Complete sets x $40=	$___________
+ shipping & handling: $5, each additional add $2.50/ set	$___________
10% discount available for orders over 100. Please call or email for shipping and handling amount
Total Order:	$___________

For additional information call 516.326.0797
E-mail: BTSlessons@aol.com