CD Order Form
Bone Risk Report, produced by LBKG Enterprises

To purchase software for “Bone Risk” graphics, please fill out the questionnaire below, print and fax. (To ensure confidentiality, we do not want any personal payment information online. Thank you.) Fax form to 760-341-9872.

Bone Risk software is copyright by LBKG Enterprises and all proceeds go to the non­profit foundation. The price is $400 for the software and technical support is available by email at no charge (within a 72 hour period). All DEXA software includes a graphic for female and a separate graphic for male bone fracture risk.

Bone Risk format requested:

_____  Hologic DEXA (male and female)

_____  Lunar DEXA (male and female)

_____  Norland DEXA (male and female)

_____  U/S Sahara (female only) 

Please print clearly (all information is required to process your order).

Are you an American College of Rheumatology member?   ___ Yes    ___ No

Language:  ____ English     ____ Spanish

Name: _________________________________________________

Address: _______________________________________________ 

_______________________________________________________

City, St, ZIP: _____________________________________________  

Telephone: ________________________________

Fax : _____________________________________

Email: ____________________________________

Credit card number: _________________________________

Name on credit card:  _________________________________

Billing address for credit card:

Address: _______________________________________________

_______________________________________________________

City, St, ZIP: _____________________________________________ 

Type: ___ Visa    ___ MasterCard

Expiration date: ________ /________ (xx/xxxx)

Or send check for $400 to:

LBKG Enterprises
21 Clancy Lane
Rancho Mirage, CA 92270 

Fax this form to: 760-341-9872

Email any questions to: LBKGenterprises@dc.rr.com