Order Form

Please print out a copy of this form and mail or fax to the address below.

NAME ___________________________________________________________

ORGANIZATION __________________________________________________

ADDRESS ________________________________________________________

CITY ____________________________ STATE _________ ZIP _____________

TELEPHONE ______________________________

FAX ______________________________

Report Number:_____________ Report Title:______________________________________

Report Number:_____________ Report Title:______________________________________

Report Number:_____________ Report Title:______________________________________

Report Cost: $10.00 per report

________ Enclosed please find my check for $__________ made payable to:
                 Bridgewater State College.

________  Please send me a bill.

Return form to: 

Jennifer Reid
Institute for Regional Development
Bridgewater State College
Bridgewater, MA 02325
Tel: (508) 531-2419
Fax: (508) 531-1707

Last Modified: July 30, 2004