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Subscription Order Form [ ] One year (12 issues) $28.97 (Canada $35.00 US; Other $42.00 US) [ ] Two years (24 issues) $54.00 (Canada $65.00 US; Other $78.00 US) Number of copies: ______ * Name: _____________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ Email: ______________________________________________ Payment method [ ] Check / Money Order US$________ [ ] Bill me [ ] VISA [ ] MasterCard Number: _______ - _______ - _______ - _______ Exp: _____ / _____ CVV/CID: _____ Signature: ___________________________________________ Mail to: Grapevine, PO Box 16867, North Hollywood, CA, 91615-6867 Phone: 800.631.6025 Fax: 818.487.4550 Online orders: www.aagrapevine.org 2-19 copies, 10% discount off the single copy price; 20-39 copies, 15%, 40 or more, 20% Give a Gift Subscription [ ] One year (12 issues) $28.97 (Canada $35.00 US; Other $42.00 US) [ ] Two years (24 issues) $54.00 (Canada $65.00 US; Other $78.00 US) Gift for: ____________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ My name: ___________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ Email: ______________________________________________ Payment method [ ] Check / Money Order US$________ [ ] VISA [ ] MasterCard Exp: _____ / _____ [ ] Bill me Number: _______ - _______ - _______ - _______ CVV/CID: _____ Signature: ___________________________________________ Mail to: Grapevine, PO Box 16867, North Hollywood, CA, 91615-6867 Phone: 800.631.6025 Fax: 818.487.4550 Online orders: www.aagrapevine.org Quiero suscribirme a La Viña Para envíos dentro de los EE.UU. [ ] Un año (6 números) $11,97 [ ] Dos años (12 números) $22,00 Para envíos fuera de los EE.UU. [ ] Un año (6 números) $14,00 [ ] Dos años (12 números) $26,00 Cantidad de suscripciones: _____ * Nombre y Apellido: _____________________________________________ Dirección: ___________________________________________ ___________________________________________ Ciudad: _________________________________ Código Postal: __________ Estado/Provincia: ___________________________ País: _______________ Teléfono: ____________________ Pago [ ] Cheque dinero adjunto por U.S. $ __________ [ ] Enviar factura (solo en EE.UU. y Canadá) [ ] VISA [ ] MasterCard N° de tarjeta: _______ - _______ - _______ - _______ Fecha de expiración: _____ / _____ CVV/CID: _____ Firma: ___________________________________________ Enviar a: La Viña, PO Box 15635, North Hollywood, CA, 91615-5635 Teléfono: 1.800.640.8781 Fax: 1.818.487.4550 Por internet: www.aagrapevine.org/espanol *2 a 19 copias, 10% de descuento del precio de una sola copia, 20-39 copias, 15%, 40 o más, el 20% Regale una suscripción Para envíos dentro de los EE.UU. [ ] Un año (6 números) $11,97 [ ] Dos años (12 números) $22,00 Para envíos fuera de los EE.UU. [ ] Un año (6 números) $14,00 [ ] Dos años (12 números) $26,00 Regalo para (Nombre y Apellido): _____________________________________________ Dirección: ___________________________________________ ___________________________________________ Ciudad: _________________________________ Código Postal: __________ Estado/Provincia: ___________________________ País: _______________ Teléfono: ____________________ Regalo de (Nombre y Apellido): _____________________________________________ Dirección: ___________________________________________ ___________________________________________ Ciudad: _________________________________ Código Postal: __________ Estado/Provincia: ___________________________ País: _______________ Pago [ ] Cheque dinero adjunto por U.S. $ __________ [ ] Enviar factura (solo en EE.UU. y Canadá) [ ] VISA [ ] MasterCard N° de tarjeta: _______ - _______ - _______ - _______ Fecha de expiración: _____ / _____ CVV/CID: _____ Firma: ___________________________________________ Enviar a: La Viña, PO Box 15635, North Hollywood, CA, 91615-5635 Teléfono: 1.800.640.8781 Fax: 1.818.487.4550 Por internet: www.aagrapevine.org/espanol La Viña Subscription Order Form [ ] One year (6 issues) $11.97 (International $14.00 US) [ ] Two years (12 issues) $22.00 (International $26.00 US) Number of copies: ______ * Name: _____________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ Email: ______________________________________________ Payment method [ ] Check / Money Order US$________ [ ] Bill me [ ] VISA [ ] MasterCard Number: _______ - _______ - _______ - _______ Exp: _____ / _____ CVV/CID: _____ Signature: ___________________________________________ Mail to: La Viña, PO Box 15635, North Hollywood, CA, 91615-5635 Phone: 800.631.6025 Fax: 818.487.4550 Online orders: www.aagrapevine.org 2-19 copies, 10% discount off the single copy price; 20-39 copies, 15%, 40 or more, 20% Give a La Viña Gift Subscription [ ] One year (6 issues) $11.97 (International $14.00 US) [ ] Two years (12 issues) $22.00 (International $26.00 US) Gift for: ____________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ My name: ___________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ Email: ______________________________________________ Payment method [ ] Check / Money Order US$________ [ ] VISA [ ] MasterCard Exp: _____ / _____ [ ] Bill me Number: _______ - _______ - _______ - _______ CVV/CID: _____ Signature: ___________________________________________ Mail to: Grapevine, PO Box 15635, North Hollywood, CA, 91615-5635 Phone: 800.631.6025 Fax: 818.487.4550 Online orders: www.aagrapevine.org
