Please fill in this form if you would like to order the Who Am I? Self Assessment Game.

Name Name * First Last
Title
Department *
Organization *
Phone
Email *
SHIPPING ADDRESS
Name (shipping) Name (shipping) * First Last
Title (shipping)
Department (shipping) *
Organization (shipping) *
Shipping Address (your order will be shipped to this location) Shipping Address (your order will be shipped to this location) *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
BILLING ADDRESS
Is the billing address the same as the shipping address? *

Is the billing address the same as the shipping address? Yes No (provide billing details below)
Name (billing) Name (billing) First Last
Title (billing)
Department (billing)
Organization (billing)
Billing Address Billing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Quantity ($340.00 plus HST per game) *
Please note: We will contact you to confirm your order and total amount owing, including shipping and handling, prior to processing your order.