Order Form
The Van Slyck (Van Slyke) Family History:
Descendants of Broer Cornelis Van Slyck from 1634-1999
by W. Barton Van Slyke, M.D.

Name:  _________________________________________________


Address: ________________________________________________


City: ______________________ State or Province: ____________


Country: ___________________ Postal or Zip Code: ____________


E-mail address: __________________________________________


Number ordered    _____    x $30.00  = $_____________

Cost:	$30.00 U.S. per book including Shipping & Handling

Make cheque or money order payable to: W. Barton Van Slyke

Mail completed order form and payment to:
W. Barton Van Slyke, M.D.
1313 Sunset Ridge
Watertown, NY 13601 USA