Surname: ........................................................        First Name: .................................................. Address: ............................................................................................................................................ ......................................................................................................................................................... ......................................................................................................................................................... ......................................................................................................................................................... Signature: ............................  Date: ...../....../......   Email Address: ...............................................

I enclose a cheque / bankdraft / credit card authorisation of $________.  (Cheques made payable to Pitcairn Island Admin).  We accept Visa / Mastercard / American Express.    Please circle appropriate card if paying by credit card:   Visa    Mastercard   AMEX Card Number:  __ __ __ __   __ __ __ __   __ __ __ __   __ __ __ __  Expiry Date:   ____/____  PLEASE REMEMBER TO INCLUDE YOUR EXPIRY DATE WHEN ORDERING  BY CREDIT CARD.  WE CANNOT PROCESS YOUR ORDER WITHOUT IT!

ALL PRICES ARE IN NEW ZEALAND DOLLARS	No of Units	Cost
2000 Official Guide to Pitcairn (English)  - (Please add postage as below)         $22.00
2000 Official Guide to Pitcairn (German)   - (Please add postage as below)         $22.00
Postage for Guide           -   New Zealand                                     $1.00
Postage for Guide           -   Australia                                             $8.00
Postage for Guide           -   Rest of World                                   $16.50
TOTAL COST NZ$