Intentional Care Performance Standards Order Form
Name of Organization:
Address:
Name and email address of contact person:
Phone:
Fax:
Method of payment:
__Visa __MasterCard __Check __Money Order
(make payable to Advocates Inc.)
Card #:
Expiration Date:
Your product comes with a one-year subscription to the Intentional Care On-Line Learning Community found at www.intentionalcare.org. You will need a user name and password to enter the Members Resource Room on the website. Is there a user-name you prefer?
If so, write it here:
We will assign a password to you.
Verification of your user name and password will be emailed to you by the webmaster@intentionalcare.org