Name: _______________________________________________________________

Address: _____________________________________________________________

City: ______________________________ State: __________ Zip: _______________

Phone (W): _________________________ (H): ________________________

The one-hour VHS video follows six patients and three physicians over two years of bone marrow transplant procedures at the UCLA Medical Center. The video tape has been praised as an important awareness tool for current patients, prospective patients, nurses and physicians.

I wish to order _____ copies of TEST PILOTS OF THE BODY at the:

a. _____ Institutional Rate (schools, hospitals, health centers) --- $199 per tape

b. _____ Individual Rate                                                                 --- $39.95 per tape
                                                                                                            ____________

                                                                                              Total:

AGREEMENT: If ordered at the individual rate, please sign the following:

I agree that the tape that I am ordering will be used by solely for viewing by myself and my family.

_____________________________
Signature

Please send check or money order to:
                                                            TEST PILOTS OF THE BODY
                                                            KUSM Montana Public Television
                                                            VCB 172
                                                            MSU-Bozeman
                                                            Bozeman, Montana 59717-0334

Questions should be addressed to the above address or you may call 406-994-3437.
E-mail inquiries may be sent to: aig@kusm.montana.edu