NW Campanologist Ad Order Form Step 1 of 2 50% If you are submitting more than one ad, please complete a separate form for each ad.Name(Required) First Last Organization(Required)Email(Required) HMA Member(Required) Yes No HMA Number(Required) Package(Required)Per IssueThree PackAnnual: 7 issuesAd Size(Required)SmallMediumLargePer Issue (Non-Member) Quantity(Required) Price: $0.00 Quantity Per Issue (Member) Quantity(Required) Price: $0.00 Quantity 3-Pak (Member)(Required) Price: $0.00 3-Pak (Non-Member)(Required) Price: $0.00 Annual (Member)(Required) Price: $0.00 Annual (Non-Member)(Required) Price: $0.00 Total Payment MethodPayPal Checkout American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
