Maxwell Quick Medical Reference Order Form

To order a copy of Maxwell Quick Medical Reference you must be a current member of AAPA. Orders that do not include your AAPA ID number and membership expiration date will not be processed.

* AAPA ID Number

* Membership Expiration Date

* PA Program Name

As a student member of AAPA, you are eligible to order one copy of Maxwell Quick Medical Reference. The price is $5.99 and includes shipping and handling.

Please note that only one order will processed for each individual student member. Multiple requests will not processed.

Personal Information

* First Name

* Last Name

Cell Phone

* Mailing Address

* City

* State

* Zip

Phone

* Email Address

This site uses a secure server. If you use a browser such as Netscape or Microsoft Internet Explorer, your credit card information will be encrypted. You should see a lock or key at the bottom of your screen. This indicates that this specific page is secure. If you do not use a secure browser, you will not be able to submit this order form and, therefore cannot order this publication via our website.

If you are prevented from ordering on-line, please contact us at 703/836-2272 ext. 3350. You may also print this order form and fax it to AAPA at 703/684-4308.

Amount to charge my credit card: $5.99

* AAPA may charge my

Visa

MasterCard

American Express

* Credit Card Account Number

* Expires (Month/Year)

* Print Name

* Indicates Response Required