The Neuro Letterhead Order Form
Montreal Neurological Institute and Hospital
* Denotes required entry

* Contact Full Name: * Phone/Local#
* Email Address
* McGill FOAPAL number or MUHC Cost Centre number:
Please select requirements:    Electronic File letterhead word template:    Preprinted- $120.00 / 500 sheets X

  Please enter all header information below for the Letterhead.
MNI Logo
* Name (First & Last Name):
Example: Dr. John Smith or John Smith, MD, PhD  
                      (Enter French Version Below- en francais)
* titre
* departement
(Enter English Version Below)
* Title
* Department
  Please enter the phone, fax locals and Email Address for letterhead footer
NOTE: Phone Extension, Fax number and the email address are optional entries
McGill - MUHC Logos
Institut et hôpital neurologiques de Montréal
3801, rue University, Bur: Montréal (Quebec) H3A 2B4
T.514.398.* Ext. F.514.398.
Montreal Neurological Institute and Hospital
3801 University Street, Montreal, Rm ###, Quebec H3A 2B4
T.514.398.XXXX Ext. XXXXXXXX F.514.398.XXXX
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