JOURNAL OF THE BRAZILIAN CHEMICAL SOCIETY Revista da Sociedade Brasileira de Química Instituto de Química da USP - Bloco 3 superior Caixa Postal 26.037, 05513-970 São Paulo - SP fone (011) 3032-2299 fax (011) 3814-3602 e-mail sbqedit@iq.usp.br 2007 SUBSCRIPTION ORDER FORM Promotion for new subscriptions: receive the 2006 issues of the Journal of the Brazilian Chemical Society and the 2007 issues for a special price (see table below). THIS IS A NEW SUBSCRIPTION A NEW SUBSCRIPTION WITH THE 2006 ISSUES A RENEWAL ORDER New subscription or renewal SBQ members in Brazil SBQ members abroad Non members personal subscription (Brazil) Non members personal subscriptions (Latin America) Non members personal subscriptions (other countries) Universities, Government and other Institutions in Brazil Universities, Government and other Institutions abroad New subscription + 2006 issues R$ 58,00 US$ 65.00 R$ 155,00 US$ 65.00 US$ 125.00 R$ 155,00 US$ 190.00 R$ 80,00 US$ 105.00 R$ 195,00 US$ 105.00 US$ 180.00 R$ 195,00 US$ 280.00 Name: PROFESSIONAL ADDRESS Institution: Address: PO Box: City: State: Zip Code: Country: Phone: Fax: E-mail: RESIDENTIAL ADDRESS Address: PO Box: City: State: Zip Code: Country: Phone: Fax: E-mail: Please send correspondence to my Professional address Residential address ALL PAYMENTS OF RESIDENTS ABROAD SHOULD BE MADE IN BRAZILIAN REAIS BY VISA CARD ONLY. Credit card (VISA) PLEASE CHARGE MY VISA CARD ACCOUNT NUMBER: SECURITY CODE: EXPIRY DATE ...../...... Amount to be debited US$.............. Authorised Name and Address of Cardholder ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... Authorised Signature of Cardholder ...........................................................................................................................................