Please print a copy of this and mail it to Dr. Keller at the address below. Or simply indicate what you would like and mail it to Dr. Keller along with your check.  S & H is $1.50 unless you are bulk ordering (please contact Dr. Keller for that cost).

Thanks! :)

Name ______________________________________

Address ________________________________

City _______________________   State ______________  Zip  ___________

E-mail _________________________

Number of sets ________  X $ 5 per set =  ____________________

  Shipping and Handling at $ 1.50 per set =  ____________________

                                                          Total       $ _________________

Make checks payable to Deaf and Hard of Hearing Ministry  and send to Deaf and Hard of Hearing Ministry, 2 Rainbow Dr., Pekin, IL 61554-2427