International Edition: __________________________________________________________

How many copies? ________   How many years? ________

Your name/address/telephone:

Name:  ________________________________________________________________________

Address: _______________________________________________________________________

_______________________________________________________________________________

City:___________________________________________________________________________

State/Province:_______________________________   Postal Code: _____________________

Country: _______________________________________________________________________

Daytime Phone Number:  _________________________________________________________

If this is a gift, list the name/address of recipient:

Name:  ________________________________________________________________________

Address: _______________________________________________________________________

_______________________________________________________________________________

City:___________________________________________________________________________

State/Province:_______________________________   Postal Code: _____________________

Country: _______________________________________________________________________

Payment amount (U.S. Dollars) $____________________

By (check one):

[ ] Check/Money Order (payable to: The Upper Room®)

[ ] VISA Credit Card   [ ] Mastercard Credit Card

Card #: _______________________________________    Exp. Date: __________________

Name as it appears on credit card: _______________________________________________

Signature:  ___________________________________________________________________

Please return this form and your check or money order to:

The Upper Room® Customer Service -- International Editions P.O. Box 340004 Nashville, TN 37203-0004

For additional information: Phone toll-free: 877-899-2780, ext. 1701 E-mail: specialservices@upperroom.org