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Evaluation & Management of Adult Hypoglycemic Disorders

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THE ENDOCRINE SOCIETY<br />

GUIDELINE ORDER FORM<br />

(Single reprint request for orders <strong>of</strong> 100 and less)<br />

PAYMENT INFORMATION: ❍ Check ❍ MasterCard ❍ Visa<br />

Card Number Expiration Date<br />

Billing Address Signature<br />

Are you a member <strong>of</strong> The Endocrine Society? ❍ Yes ❍ No<br />

8401 Connecticut Avenue, Suite 900<br />

Chevy Chase, MD 20815-5817<br />

Phone 301.941.0210; Fax 301.941.0257<br />

societyservices@endo-society.org<br />

FEIN 73-0521256<br />

PRODUCTS QTY. PRICE (USD) SUBTOTAL<br />

Member Non-Member<br />

Androgen Therapy in Women $15.00 $20.00<br />

Case Detection, Diagnosis & Treatment <strong>of</strong> Patients with Primary $15.00 $20.00<br />

Aldosteronism<br />

The Diagnosis <strong>of</strong> Cushing’s Syndrome $15.00 $20.00<br />

<strong>Evaluation</strong> & <strong>Management</strong> <strong>of</strong> <strong>Adult</strong> <strong>Hypoglycemic</strong> <strong>Disorders</strong> $15.00 $20.00<br />

<strong>Evaluation</strong> & Treatment <strong>of</strong> <strong>Adult</strong> Growth Hormone Deficiency $15.00 $20.00<br />

<strong>Evaluation</strong> & Treatment <strong>of</strong> Hirsutism in Premenopausal Women $15.00 $20.00<br />

<strong>Management</strong> <strong>of</strong> Thyroid Dysfunction during Pregnancy & Postpartum Executive Summary Executive Summary<br />

(MMTD07)—$10.00 (MMTD07)—$15.00<br />

Guideline (MTSD07)— Guideline (MTSD07)—<br />

$10.00 $15.00<br />

Prevention & Treatment <strong>of</strong> Pediatric Obesity $15.00 $20.00<br />

Testosterone Therapy in <strong>Adult</strong> Men with Androgen Deficiency Syndromes $15.00 $20.00<br />

Primary Prevention <strong>of</strong> Cardiovascular Disease & Type 2 Diabetes in $15.00 $20.00<br />

Patients at Metabolic Risk<br />

Miscellaneous<br />

TOTAL All prices include sales tax $<br />

If you are a member and you know your member ID, please provide: ___________________________________________________________<br />

Prefix: First Name (Given): Middle: Last (Surname):<br />

Institution/Company: Dept/Div:<br />

Street/PO:<br />

City: State/Province: Zip/Mail Code: Country:<br />

Telephone: Fax: Email:<br />

Degree(s) that you would like listed after your name: Pr<strong>of</strong>essional Title: Date <strong>of</strong> Birth: Gender:<br />

❍ Male ❍ Female<br />

Which <strong>of</strong> the following best describes your primary pr<strong>of</strong>essional role? Race or Ethnic Affiliation (voluntary)<br />

(Please mark only one) ❍ African American, Black<br />

❍ Administrator ❍ Retired ❍ Asian<br />

❍ Basic Researcher ❍ Teacher/Educator ❍ Hispanic<br />

❍ Clinical Practitioner ❍ Fellow (Clinical) ❍ Native American, Eskimo, Aleut<br />

❍ Clinical Researcher ❍ Fellow (Postdoctoral/Research) ❍ Pacific Islander<br />

❍ Industry/Corporate Pr<strong>of</strong>essional ❍ Student ❍ White, Caucasian<br />

❍ Nurse/Healthcare Pr<strong>of</strong>essional ❍ Other___________________________________ ❍ Other___________________________________

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