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White Coat Ceremony Order Form

WHITE COAT CEREMONY ENTERING CLASS OF 2007

Please send me ______ copy/copies of the DVD

Enclosed is my check for $_______________ ($15 per copy -- payable to UTHSC).

Tape should be mailed to:_________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

OR

DVD will be picked up by:

___________________________________________________

(name).

Please return NO LATER THAN NOVEMBER 1, 2007 to:

Marcia Winkler
Student Affairs
6431 Fannin, Suite G.400
Houston, TX.   77030.

DVD’s will be shipped by November 30th.