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Please make checks payable to:
Celiac Disease Center at Columbia University.
To purchase any of the above items by check,
please mail the form below, with your check, to:
Cynthia Beckman
Celiac Disease Center at Columbia University
Harkness Pavilion
180 Fort Washington Avenue
Suite 934
New York, NY 10032 |
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| NAME: |
_____________________________________________________________________ |
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| ADDRESS: |
________________________________________________ ZIP CODE:___________ |
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| FAX: |
__________________________ PHONE: ____________________________ |
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| EMAIL: |
_____________________________________________________________________ |
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| Which items: |
____ Gluten – Free & On The Go Pocket Guide |
$16 |
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____ Audiotapes for Patient Education Day 2004 (set of 2 tapes) |
$55 |
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____ Nothing Beats Gluten-free Cooking (CDCC at Columbia cookbook for children) |
$25 |
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____ Gluten-Free Lifestyle Pyramid |
$12 |
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____ Gluten-Free Lifestyle Pyramid Tear-Off Pad |
$70 |
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____ Gluten-Free Dining Card |
$40 |
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____ Make a donation to the Celiac Disease Center at Columbia |
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TOTAL AMT ENCLOSED: ___________
I WOULD LIKE TO CONTRIBUTE $_________ to the Celiac Disease Center at Columbia.
FOR ADDITIONAL INFORMATION contact:
Cynthia Beckman
Telephone: 212-342-4529
Email: cb2280@columbia.edu |
