HILLEMAN FILM ORDER FORM
Hilleman: A Perilous Quest to Save the World's Children
Film has a run time of 1 hour and 7 minutes.
Disc also includes nine feature animations.
English language
Distributed by Vaccine Education Center
Order by one of the following methods:
1.Fax to the Vaccine Education Center at
215-590-2025.
2.Call us at 215-590-9990.
3.Email us at [email protected].
(For your protection, please do not include credit
card information in your email. Please call the VEC
with this information.)
4.Visit our website at vaccine.chop.edu/order.
5.Mail to the address below, Attn.: Denise Freeman
Pricing varies by quantity ordered in a single format.
For more information about the
Vaccine Makers Project, go to
www.vaccinemakers.org.
Quantity
Price per disc
1–9
$12
10 – 99
$10
100 – 499
$8
500 or more
$5
For shipping, please include:
Name ____________________________________________________________________________
Company _________________________________________________________________________
Street Address ____________________________________________________________________
City ______________________________________________ State ________ ZIP _____________
Please indicate your order below.
Format
Quantity
Cost
DVD
Phone ___________________________________ Fax ____________________________________
For billing, if address differs, please include:
Name ____________________________________________________________________________
Practice/Company ________________________________________________________________
Street Address ____________________________________________________________________
City ______________________________________________ State ________ ZIP _____________
Phone ___________________________________ Fax ____________________________________
Blu-Ray
Subtotal:
Shipping*:
Total:
*Shipping charges will be added. For example, one to 10 pieces ship to a U.S. location for $5. Charges for larger
quantities can be viewed in the "DVD section" of this page: vaccine.chop.edu/shipping. Shipping for international
orders will be determined at the time of order. Please contact the Center at 215-590-9990 for assistance.
Payment method:
q Check or money order
q Purchase Order # ___________________
(made payable to the Vaccine Education Center • mail to Attn: Denise Freeman)
q MasterCard q Visa q American Express q Discover
Card number: _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ Exp. date: _ _ / _ _ (mm/yy)
Name as it appears on credit card: _________________________________________________
Please allow three to four weeks for delivery; larger orders may be subject to additional time.
If you require this by a certain date, please specify: ______________________________________________
Signature: ________________________________________________________________________
Vaccine Education Center at Children’s Hospital of Philadelphia
3615 Civic Center Blvd., ARC Room 1202, Philadelphia, PA 19104-4399
Phone: 215-590-9990 • Fax: 215-590-2025
©2016 Children’s Hospital of Philadelphia, All Rights Reserved.
17VEC0109/NP/11-16