Ynez Violé
O’Neill
Academic Video Purchase Form
(For use in snail-mail only)
Please return with check payable to the Ynez Violé O'Neill.
Video Title: _________________________________________________________
(California residents please add sales tax of 8.25%)
Processing and reproduction fees: $85.00 :____________
Name: _______________________________________
Address: ______________________________________
_______________________________________________
Send to:
Professor Ynez Viole O'Neill
Medical History Division
Department of Neurobiology
UCLA School of Medicine
10833 Le Conte Ave.
Los Angeles CA 90095-1763
(also available in SECAM or PAL
version upon request at the additional cost of $20.00 for a total cost of $100.00)