PALATINE Products and Publications Order Form

Please could you complete all the sections of this form. Unfortunately due to limited resources, PALATINE can only supply one copy of each DVD to any one institution. Colleagues who order the materials are encouraged to share them within their institution.

Title(s) of requested resource(s):
(If you wish to select several resources, please hold down the CTRL button)

*Full Name:

*Email address:

Position:

Institution:

*Departmental administrator:

Postal address:

*Postcode:

Signature Declaration

The distribution of these particular resource(s) is limited to colleagues in UK higher education and use of them is restricted to non-commercial learning, teaching and research purposes.

I work in the UK higher education sector and agree to use the resources according to the stated terms and conditions

I agree to the information I have supplied on this form being stored in an electronic format by PALATINE, in accordance with accordance with Data Protection principles.