“The Family of James Blair and Nancy Day”
                              a book by Dr. Roger D. Grider

                                       ORDER FORM


To order, please fill out the form below, with a check (payable to Roger D. Grider)
and mail to:

                           Roger D. Grider
                           6209 Orion Road
                           Louisville, KY 40222
                           
($36.00 plus $4.00 p/h = $40.00 per copy)
(Non-U. S. orders contact author for price and postage differential.)
                           

______________________________________________BSGR/CBS Member No: _______________
Name:   (please print clearly)
 
________________________________________________________________________________
Street address:

_________________________________________________________________________________
City or town 				State			Zip Code +4

Contact e-mail, if any _____________________________  or  Phone _________________


Number of copies:	___________		Total enclosed  $_______________
    @ $36.00 plus $4.00 p/h each