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Order form
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"Mama? Does your heart hurt?"
"No. Go back to sleep, ma tourterelle. I'm just going to get some oxygen and then I'll lie down beside you." "Does it hurt?" "What, the oxygen? No. It's like a little breeze in your nose." "It tickles, eh?" I laugh. "Yes, that's it. It tickles. Go back to sleep now." Obediently you close your eyes, confident, ready to find your dreams again... Tomorrow, when you leave, I'll try not to cry. I want you to remember my smile in case you never see it again. |
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Use the following form to order the book
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Please, answer all the questions. Allow at least 3 weeks before you receive the book. |
You can also send your check (20.00$) directly to
La Fondation Diane Hébert
132 rue Blainville est,
Ste-Thérèse de Blainville (Québec)
Canada, J7E 1M2
| First name | Last name | ||
| Address | Apartment | ||
| City | Province or state | ||
| Country | Postal Code or Zip Code | ||
| Area code and phone number at home | Area code and phone number
at the office |
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| Quantity of book you want (25$ each)
This price includes the shipping |
E-mail address | ||
Please charge me on my 
Here is the number of my Visa card |
Expiration date of my VISA | ||
Please charge me on my 
Here is the number of my Master-Card |
Expiration date of my
MASTER-CARD |
Send
E-mail to "La Fondation Diane Hébert"
[ Index ]
"La Fondation Diane Hébert"
132 rue Blainville est, Ste-Thérèse de Blainville
(Québec) Canada, J7E 1M2
Tél.: (450) 971-1112 - Fax : (450) 971-1818 - Toll free #
1 877-971-1110
