Mail Order Purchases (Books and DVDs), Donations and Membership.  
(The filling in of this form is optional. The order can be placed with a personal memo indicating relevant details and a cheque) 

Print the page and fill out the information requested in the form on the printed copy. Send the form with your order to

Centre for Research on Globalization (CRG)
PO Box 55019
11 Ouest Notre-Dame,
MONTREAL, Qc, H2Y 4A7
CANADA

NAME IN FULL

………………………………………………………………………………..
POSTAL ADDRESS (including postal code)

…………………………………………………………………………………
(Street and No)

…………………………………………………………………………………   
(City, State/Province. Area Code, Country 

Tel number (indicate country and area codes) ……………………………… Email:………………………………. (tel /email for followup only, remain confidential)

If you wish to send the books/DVDs to another address than your own or to a friend, indicate detals below, (otherwise leave blank)

…………………………………………………………………………………
Name (if different from above).

…………………………………………………………………………………
(Street and No)

…………………………………………………………………………………
(City, State/Province. Area Code, Country 

For the purchase of (indicate the item or items purchased, books or dvd, quantities and price).

1…………………………………………………………………………………

2…………………………………………………………………………………

3…………………………………………………………………………………
Indicate total amount US or Can$…………………… plus s and h charges (………..), to be added to your order. 
TOTAL (purchase plus s and h) ………………… 
Include airmail surcharge if applicable. See online store for details)
If Donation and/or Membership (annual)………………………………………. (specify and indicate amount) USor Can$………….
Make Cheque out to the Centre for Research on Globalization (CRG) or CRG (US or Can $). If US Postal Money Order (International redeemable outside US)
Signature ………………………………………….