ORDER FORM - University of Nebraska Medical Center · 2011. 6. 3. · Set 2: Molecular...
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These products were created with funding from a Science Education Partnership Award from the National Center For Research Resources, National Institutes of Health Co-funded by the National Institute of Biomedical Imaging and BioEngineering Grant # 1 R25 RR022707 ORDER FORM SHIP TO ADDRESS (please print or type) Customer Name Date University of Nebraska Medical Center Science Education Partnership Award Website http://www.unmc.edu/sepa To see samples of products, go to our website. Order by mail: UNMC – SEPA office 986660 Nebraska Medical Center Omaha, NE 68198-6660 Order by fax: Send completed order form to: (402) 559-5050 Order by email: E-mail .pdf copy of order form to [email protected] All Sales are Final. Please contact us if we made an error in filling your order. If product you receive is defective, you can receive a replacement if defective item is mailed back to us within 30 days of purchase with a note explaining the flaw. For questions or to verify receipt of fax Contact us at: (402) 559-8106 8:00 AM – 4:30 PM Central Time, Monday - Friday Contact us for pricing on bulk orders. Organization / School Name Street Address City State Zip Code Province/Territory International Postal Code Country Daytime Phone Number Fax Number E-Mail Address METHOD OF PAYMENT (please print or type) VISA MasterCard Credit Card Number Expiration Date Cardholder’s name as it appears on the card CVV/CVC Code Billing Address (Street) (City, State Zip) Check or Money Order enclosed for $ ______________ (Payable to UNMC in U.S. Dollars) To ensure your order is processed, please include correct amount. Product Description Unit Price Quantity Total Price Role Model Posters (each set contains five 8½”×11” teacher sheets, five 11”×17” individual posters, and one 18”×24” composite display poster) Set 1: Physician, School Psychologist, Radiology Technologist, Nurse, Environmental Engineer $ 35 Set 2: Molecular Immunologist, Dentist (male), Occupational Therapist, Science Teachers $ 35 Set 3: Veterinary Technician, Social Worker, Dentist (female), Astronaut, Anthropologist $ 35 Set 4: EMT, Firefighter, Industrial Tech Teacher, Clinical Services Administrator, Agricultural Manager $ 35 Set 5: Executive Director, Buffalo Herd Mgr, Veterinarian, Chemical Engineer, Environmental Specialist $ 35 Trading cards featuring all 5 poster sets ( 3½”×2½”) $ 15 Lab Safety Set of 10 different topics (11”×17”) $ 25 Wash Your Hands, Laminated (sold in a set of 5) (8½”×11”) $ 15 Curriculum Ethnobotany Curriculum $25 Subtotal $8 for one item, all additional items add $1 each Shipping & Handling Nebraska Only add 7% for Omaha and Lincoln or 5.5% all other businesses. All tax exempt organizations must provide tax exempt sales certificate. Tax To ensure your order is processed, please include correct amount. Make Checks Payable to: UNMC Total Please send completed order form and payment to: UNMC – SEPA office 986660 Nebraska Medical Center Omaha, NE 68198-6660
Transcript of ORDER FORM - University of Nebraska Medical Center · 2011. 6. 3. · Set 2: Molecular...
These products were created with funding from a Science Education Partnership Award from the National Center For Research Resources, National Institutes of Health Co-funded by the National Institute of Biomedical Imaging and BioEngineering Grant # 1 R25 RR022707
ORDER FORM
SHIP TO ADDRESS (please print or type)
Customer Name
Date University of Nebraska Medical Center Science Education Partnership Award Website http://www.unmc.edu/sepa To see samples of products, go to our website. Order by mail: UNMC – SEPA office 986660 Nebraska Medical Center Omaha, NE 68198-6660 Order by fax: Send completed order form to: (402) 559-5050 Order by email: E-mail .pdf copy of order form to [email protected] All Sales are Final. Please contact us if we made an error in filling your order. If product you receive is defective, you can receive a replacement if defective item is mailed back to us within 30 days of purchase with a note explaining the flaw. For questions or to verify receipt of fax Contact us at: (402) 559-8106 8:00 AM – 4:30 PM Central Time, Monday - Friday Contact us for pricing on bulk orders.
Organization / School Name
Street Address
City
State Zip Code
Province/Territory
International Postal Code
Country
Daytime Phone Number
Fax Number
E-Mail Address
METHOD OF PAYMENT (please print or type)
VISA
MasterCard
Credit Card Number
Expiration Date
Cardholder’s name as it appears on the card
CVV/CVC Code
Billing Address (Street)
(City, State Zip)
Check or Money Order enclosed for $ ______________ (Payable to UNMC in U.S. Dollars)
To ensure your order is processed, please include correct amount.
Product Description Unit Price Quantity Total Price
Role Model Posters (each set contains five 8½”×11” teacher sheets, five 11”×17” individual posters, and one 18”×24” composite display poster)
Set 1: Physician, School Psychologist, Radiology Technologist, Nurse, Environmental Engineer $ 35
Set 2: Molecular Immunologist, Dentist (male), Occupational Therapist, Science Teachers $ 35
Set 3: Veterinary Technician, Social Worker, Dentist (female), Astronaut, Anthropologist $ 35
Set 4: EMT, Firefighter, Industrial Tech Teacher, Clinical Services Administrator, Agricultural Manager $ 35
Set 5: Executive Director, Buffalo Herd Mgr, Veterinarian, Chemical Engineer, Environmental Specialist $ 35
Trading cards featuring all 5 poster sets ( 3½”×2½”) $ 15
Lab Safety
Set of 10 different topics (11”×17”) $ 25
Wash Your Hands, Laminated (sold in a set of 5) (8½”×11”) $ 15
Curriculum
Ethnobotany Curriculum $25
Subtotal
$8 for one item, all additional items add $1 each Shipping & Handling
Nebraska Only add 7% for Omaha and Lincoln or 5.5% all other businesses. All tax exempt organizations must provide tax exempt sales certificate. Tax
To ensure your order is processed, please include correct amount. Make Checks Payable to: UNMC Total
Please send completed order form and payment to: UNMC – SEPA office
986660 Nebraska Medical Center Omaha, NE 68198-6660
Science Lab Safety Posters
Science Education Partnership Award (SEPA)
The long term goal of SEPA is to stimulate student interest in science, to encourage exploration of health careers, and ultimately to increase Native American representation in health and science fields.
Dr. Maurice Godfrey serves as the principal investigator of SEPA, which is funded by the National Center for Research Resources, National Institutes of Health, United States Department of Health and Human Services. Grant # 1 R25 RR022707
The target population is Native American students grades K‐8 and their classroom teachers. Partner schools include 13 public and tribal grant schools; 12 are located on or near reservations in Nebraska or South Dakota (Omaha, Santee, Winnebago, Sisseton ‐Wahpeton, Yankton, Rosebud), and one is in downtown Omaha.
Over the past five years, our most successful efforts have been teacher professional development workshops and summer science camps for middle school students. The teacher workshops have been instrumental to provide teachers, who work in isolated schools on Indian reservations, with resources to improve their science instruction.
All proceeds made from the sale of these posters go to fund future health and science outreach projects for our partner schools on reservations in Nebraska and South Dakota.
www.unmc.edu/sepa
Native American Role Model Posters
