CENTERING HEALTHCARE INSTITUTE, INC. SUPPLIES ORDER FORM - For a printable Order Form in pdf, click here (may take a while to appear) - To view pictures of most of these products, click here |
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Shipping Chart (Shipping is on the total amount, BEFORE any discounts..) If your Order Total is: Please add Under $50 $10.00 $50-99 $15.00 $100-199 $20.00 $200-299 $25.00 $300-399 $30.00 Over $400 9% Orders outside the contiguous US, please call for rates: (203)271-3632 |
Order Total $ ________ Shipping/Handling (see chart) $ _________ Sales tax 6% (CT addresses only) $ _________ Total cost $________ |
Note - A more printable and useable Order Form, in pdf format, can be accessed & printed by clicking here. This form is included on the web site here for your information, but may not print out appropriately. Use of the pdf form is recommended. It can then be mailed or faxed to CHI. |
* For Notebook discounts, Member agency number is: _________________________ |
Contact Name ______________________________________ Phone _____________________ (for order questions) Practice / Institution ______________________________________________________________ Email __________________________________________ Order date _______________ ____ Check (made out to "CHI") ____________________ Purchase Order number ___ Credit card ____________________________________Exp. Date __________ Name on card _______________________________________ ___Please send invoice to: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Ship order to: _______________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ |
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(Click here, to go to a more printable Order Form, in pdf format) Fax or mail Order Form to: CHI, 558 Maple Ave., Cheshire, CT 06410 Tel: (203) 271-3632 / Fax: (203) 272-3460 email: kpanda@centeringhealthcare.org (click on, to contact now) |
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copyright© 2009
Centering Healthcare Institute Inc. Web site created/managed by Ron Rising, Rising Images ron@risingimages.com / www.risingimages.com |
_____ CHI Institutional Site Membership Provides discounts on Notebooks, listing
(non-profit) on CHI website, use of Centering name.logos, phone/e-mail consultation--good for 1 year (for profit) _____ Centering Handbook _____ Information Kit: Help everyone decide if Centering will work for your agency. 2 Information Booklets 2 CD business cards with PowerPoint 2 brochures each for CHI, CenteringPregnancy®, CenteringParenting® _____ "Ask Me About Centering" Button _____ English _____ Spanish _____ Facilitation Monograph Learn more about effective facilitation techniques. _____ Centering Pregnancy® blank note cards (5 cards with envelopes) _____ Facilitator's Guide to Mom's Notebook (2-pack for co-facilitators) ___ with English Mom's NB ___ with Spanish Mom's NB _____ Facilitator's Guide to Mom's Notebook (extra copy) ___ with English Mom's NB ___ with Spanish Mom's NB _____ 1" round chart stickers (20/sheet) ____ CPregnancy ____CParenting _____ Centering Healthcare Institute pens _____ CenteringPregnancy® promotional laminated poster (11x17") _____ "Centering Offered Here" promotional poster (18x24") __ Blue __ Yellow _____ Patient brochure for CenteringPregnancy® _____ Eng _____ SP _____ Patient brochure for CenteringParenting® _____ Eng _____ SP _____ Recruitment Kit: Promote your CenteringPregnancy® groups with these tools! - 100 Patient Brochures ( choose - ___ Eng ___ Sp) - 5 CHI rainbow pens - 20 CenteringPregnancy® buttons ( ___Eng ___ Sp) - SAMPLE Infant hat - 1 CenteringPregnancy® promotional poster - 5 CenteringParenting® brochures - DVD with Patient Recruitment PowerPoint ___ Eng ___ SP ___ bilingual _____ CHI shirt V-neck ___ M ___ L ___XL ___ 2XL Round neck ___ S ___ XL DVDs _____ Patient Recruitment DVD (looping PowerPoint) __ Eng __ Sp ___Bilingual Group Supplies (*items discounted 10% for CHI Institutional members) _____ Mom's Notebook*, tote bag,growth illustration pamphlet Regular Price _____ English _____Spanish CHI Member Price _____ Family Notebook* (English) w/tote bag Regular Price CHI Member Price _____ "Centering Baby" infant hat* ____ Eng ____ Sp _____ Bilingual Group Guidelines laminated poster (bilingual Eng/Sp) _____ Bilingual Set of Contraceptive Placards (15) (bilingual Eng/Sp) _____ Squishy Balls for group games (set of 3) _____ Bilingual Agree/Disagree paddles (set of 12) (bilingual Eng/Sp) _____ Bilingual A/D Cards _____ Domestic Violence* _____ Baby Care _____ Oral Health _____ Leader's Kit: everything you need to run fun and interactive Centering groups! 1 star pillow 1 double-sided Centering tote bag 1 sheet of chart stickers 1 Native American talking stick 1 set Agree/Disagree paddles Personal Goals cards, beads, cups 1 each of domestic violence, baby care, 1 set of 3 squishy balls oral health Agree/Disagree cards 12 nametags with fun stickers 15 CHI pens 1 skein of yarn 1 Group Guidelines poster 1 set of Contraceptive Cards The Pocket Midwife, by Susan Feckety,CNM |
$250.00 $ ______ $500.00 $ ______ $150.00 $ ______ $ 20.00 $ ______ $ 1.50 $ ______ $ 20.00 $ ______ $ 7.50 $ ______ $125.00 $ ______ $ 75.00 $ ______ $ 2.00 $ ______ $ 1.00 $ ______ $ 9.00 ea $ ______ $ 20.00 ea $ ______ $ 25.00/100 $ ______ $ 25.00/100 $ ______ $ 60.00 $ ______ $ 20.00 $ ______ $ 20.00 $ ______ $ 20.00 $ ______ $ 22.00 $ ______ $ 22.00 $ ______ $ 20.00 $ 6.00 $ ______ $ 7.00 $ ______ $ 30.00 $ ______ $ 15.00 $ ______ $ 35.00 $ ______ $ 10.00 ea $ ______ $200.00 $ ______ ________ |
(1/09) |