International eBook Request

First Name*

Last Name*

Affiliated Organization*

Instructor's Organization Email*

Organization address*

Organization City*

Organization Country/Region*

Current Job Title(s)

I have already adopted this title for my course and am requesting course materials (e.g. a Desk Copy).

.
.

Type of Request*

Estimated Course Start Date

Enrollment

eBook Title & Author*

eBook ISBN

International Sales Contact (name and email)*

Form Name

Notes

Please keep me updated on Jones & Bartlett Learning news, event and offers.  I can unsubscribe at any time.