To pay by check or money order

Orders for 1 program only, complete Sections A & C.
Orders for 2 or more programs, complete Sections A & B.

(*Note: If ordering 5 or more programs, you qualify for a volume discount. Contact us for details at:
info@nshcoa.com or(931) 967-0894)

IF YOU HAVE A GROUP or ORDER ID, ENTER IT HERE: ____________________

Section A              PLEASE PRINT LEGIBLY

Product Description	Quantity	Total Cost	Add S&H Charges depict shipping to ONE location	Total Due
Evidence-based Health Coaching for Healthcare Providers 2nd Ed: $410 ea 5 or more programs-or shipping to more than one location, email: info@nshcoa.com for pricing and shipping charge Companion Health Management & Prevention Teaching Guides: Each quantity for each CHF __ CAD __ COPD__ Diabetes __ HTN __ Pressure Ulcers __ Pain Mngmt ___ 1-24=$3.50 ea. 25-49=$3.25 ea. 50-99=$3.00 ea. 100-249=$2.75 ea. 250-499=$2.50 ea 500 or > email info@nshcoa.com for pricing & shipping charge All International orders include S/H: $37.50 USD for each program ordered			1 Prgm $15 2-4 Prgms $30 1-24 $5.00 25-49 $10.00 50-99 $15.00 100-249 $20.00 250-499 $25.00
Make check or money order payable to: Miller & Huffman Outcome Architects, LLC (MHOA) Mail To: MHOA 221 Victor Lane Ringgold, GA 30736

SECTION B (Complete only if ordering 2 or more programs)

Upon receipt of payment and this order form, the contact person listed will receive an email containing a Group ID and login instructions to be shared only with each person receiving a program. Following these instructions, each person is required to enter his or her personal information into the NSHC website order page to activate their personal membership and enter the member's area.

(All Programs in the order will be shipped to the Location entered below)

Company Name: __________________________________________________________________________________

Contact Person: ___________________________________________________________________________________

Street Address: ____________________________________________________________________________________

City: _________________________________________________________________ State: _______ Zip: ____________

Email: ___________________________________________________________ Phone: __________________________

Country Code
(if applicable): _____________________________________________________________________________________

 

SECTION C (Complete only if ordering one program)

1. Full name w/ middle initial: __________________________________________________________________________

2a. Address/City/State/Zip: ____________________________________________________________________________

2b. Shipping Address (if different) ______________________________________________________________________

3. Credential (MD, RN, RPT, etc) _____________

4. Active License or Credential #: _______________________

5. Licensed in what State/Country? _________________ Date Lic/Credential expires __________________

6. Email address: __________________________________________________________________________________

7. Phone: ______________________________

8. How did you find out about us? ______________________________________________________________________