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"Partners Towards Balance" Project ORDER FORM

Please print off this order form and send the completed form with enclosed payment to the Short Term Child Care Program at the address indicated below.

Organization name: ___________________________________________________________

Shipping Address: ____________________________________________________________

State/Province: ________________ Postal Code/Zip code: ____________________

Contact person: ___________________________ e-mail: ____________________________

Tel.:___________________________ Fax: ________________________________

Please tick which items you would like to order

"Partners Towards Balance" Executive Summary ......................................... $9.95
(7 pg. report) postage and handling ......................................................... $3.50

"Partners Towards Balance" Final Report .................................................... $24.95 postage and handling ......................................................... $3.50

"Partners Towards Balance" Video............................................................... $14.95
postage and handling ......................................................... $3.50
(14 minute educational video profiling the joint management-labour initiative -
the National Capital Region Emergency Child Care Consortium and the emergency
child care service provided by the Short Term Child Care Program)

If ordering two or more items, postage and $5.00 handling is U.S.customers
add $5.00 (CDN) to each order. TOTAL COST................................... $____________

Please send completed order form and cheque or money order payable to: Short Term Child Care Program 700 Industrial Ave., Suite 600 Ottawa, Ontario K1G 0Y9 CANADA

N.B. Payment must be in Canadian dollars.