subscription | Parkhurst Exchange

Subscription Information

*To find out if you qualify for a free subscription to Parkhurst Exchange, choose "Complimentary Subscription" in the drop down subscription list to the left and fill out the "Personal Information" below. Please include your medical specialty and email address. Submit this form and we will let you know by email if you qualify.

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Date of Back Issue

Canadian subscription prices include GST. PST will be added to Quebec residents

Personal Information

Organization

Name (First, Last)

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Medical Specialty

Address

City / Province

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Country

Telephone

Area code	Number	Ext.
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Payment Information

NOTE: This is NOT a secure server. If you prefer not to send your Credit Card Number through the Internet, leave this area blank and fill in your telephone number above where you can be reached during business hours and a Parkhurst representative will contact you.

Payment Method

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Expiry Date

** Make cheque payable to: Parkhurst Publishing