Get your Personalized, Autographed Copy of

Code Blue: A Katrina Physician's Memoir
1. Print out and complete this order form

2. Mail to: Code Blue,  9825 Debra Dr., River Ridge, LA 70123

3. Make check payable to: Richard Deichmann


Code Blue Order Form

Shipping Information:
(Allow 2 weeks for delivery)

Ship to:

Name                    _______________________________________

Street Address      _______________________________________

City, St., Zip Code _______________________________________


Payment:

Price$19.95
Shipping/Handling      $5.00  (Free Shipping/Handling on orders of five or more)

Total$24.95/copy

Number of copies        X_________

Total cost                     _________



Personalized Inscription request with Autograph:

Copy 1:______________________________________________________________________

Copy 2:______________________________________________________________________

Copy 3:______________________________________________________________________