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Mailing List Contract

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					                                         Mailing List Rental Contract



General information: The ACP full membership is approximately 3,000 members. Mailing list orders
must be accompanied by a copy of the promotional or informational mail piece to be mailed and are
subject to approval. Upon approval, the member information will be sent only to a bonded mailing house
for a one-time use. If you do not have a bonded mailing house, the College will supply you with the
contact information for a bonded mailing house. Please contact Carla Baker at (312) 573-1260, extension
222, with any questions.

Date Ordered:                                       Date Needed:
Company/Organization Name:
Contact:
Address:
City:                                    State:                      Zip:
Phone:
E-mail:
Mailing House Contact: ____________________________________________________________
Mailing House E-mail:


                                (Please select your audience)
Region:             US only               Non-US, excluding Canada  Canada only

Member Types:       Regular Members       International                    Students
                    Academic Alliance     Retired Members                  Dental Technicians

Method of Payment: (Payment must be received in order to process your order.)

        Quantity of Names          Non-Member Rental Fee                 Member Rental Fee

        Up to 1500 names                           $750                           $500
        1501 – 3000+ names                        $1200                           $750

                 American Express                 Master Card                   Visa
Credit Card Number:
Expiration Date:
Cardholder’s Signature:

                                          Please return to:
                                   American College of Prosthodontists
                                              Carla Baker
                                      Associate Executive Director
                                    211 E. Chicago Ave., Suite 1000
                                           Chicago, IL 60611
                                          Fax: (312) 573-1257

				
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posted:11/26/2011
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