Term	US	Outside US Surface*	Outside US Airmail
1 year	$15.00	$21.00	$35.00
2 years	$28.00	$40.00	$68.00
3 years	$39.00	$57.00	$99.00
*Circumstances beyond our control may delay delivery outside North America by surface shipping up to two months.

___ New Subscription
___ Renew Subscription
Billing Address:
Full Name or Facility Name: _______________________________________________________
Address: _______________________________________________________________________
City,State and Zip: ______________________________________________________________
Phone: ____________________       *E-mail: __________________________________________
This is a gift from: ________________________________________________________________
Credit to Lifeline Representatives: ____________________________________________________
Shipping Address (magazine will be sent to this address):
This address is the same as my billing address. If different, complete fields below. If you change something on the form above, you must check this button again or your change won't be recorded below.
Full Name or Facility Name: ____________________________________________________________________
Mailing Address: ______________________________________________________________________________
City, State and Zip: ____________________________________________________________________________
Length of Subscription: _____ 1 Year   _____ 2 Year   _____ 3 Year
___ Yes, I want to be a Lifeline Rep and promote Lifeline magazine.        Put me on the Rep list and send me a Rep Kit.
___ Renew me as a Lifeline Rep.
___ Delete me from the Rep List.
Lifeline Challenge participants must include the following information.
Group Number: __________________
Name of Group Contact: ____________________________________________________________________
Group Location: ___________________________________________________________________________
Meeting Day and Time: _____________________________________________________________________
Group Contact Address: _____________________________________________________________________
City, State, and Zip: _________________________________________________________________________
If you wish to pay by check or money order, complete this order form, print it, enclose with check made payable to World Service Office  and mail to: World Service Office P.O. Box 44020 Rio Rancho, NM 87174-4020 USA If you have questions or concerns about your order, contact the WSO by calling 505-891-2664 or e-mail to info@oa.org.