Order form for "Qigong for Health" video

[THIS IS NOT AN ON-LINE FORM.]
Fill in the form; then PRINT it and mail to IEP(credit card orders may be faxed):

The Immune Enhancement Project
3450 Sixteenth Street
San Francisco, CA 94114
415/252-8710 (fax)

Ordered by:

    First Name: Last Name:

Street Address:  Telephone:

          City:        Fax:

         State:  ZIP:

      

Ship to (if different):


    First Name: Last Name:

Street Address:  Telephone:

          City:        

         State:  ZIP:

      

Payment information:


                      

Type of payment: Check or Money Order  MasterCard  Visa

 

Account number: Expiration date: 

 

     Signature:



($39.95 each) Quantity:  Total: 

CA Sales Tax (8.5%):                 

Shipping:                            

Total Enclosed: