PURCHASE ORDER FORM FOR How Best to: Learn and Remember for Leaving Certificate

Please print off and complete ALL sections of this form, and return with payment in full to:

The Memory Academy
47 Brooklands
Nutley Lane
Dublin 4
IRELAND

FIRST NAME: _________________________ FAMILY NAME: _______________________

EMAIL ADDRESS: ____________________ CONTACT TELEPHONE NUMBER: _______

MAILING ADDRESS: __________________ ARE YOU CURRENTLY STUDYING?   Y*   N*

                                        __________________ IF SO, WHAT COURSE? __________________

                                        __________________

                                        __________________

I WOULD LIKE TO PURCHASE _______ COPIES(S) OF THE BOOK.

I ATTACH A   POSTAL ORDER*  /BANK DRAFT*   IN THE AMOUNT OF €_____

*PLEASE CIRCLE AS APPROPRIATE

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