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Mail in Order Form
Use your browser to print this form and mail it with a check or money order (payable to Regents - UC) in US funds against a US bank to: HAPI Online UCLA Latin American Center 10343 Bunche Hall University of California, Los Angeles, 90095-1487 U.S.A.
Name:
Type of Account	Annual Monthly
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Contact Person:
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Fax number of contact:
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If yes, please supply the URLs for your link and link graphic
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