Please print, fill out, and return to us.
Vance Bonner, Ph.D., 21173 Sunburst Ct., Bend, OR 97702  (541) 330-9070

(Please print)
Name:______________________________ Home Phone:___________________

Address:__________________________________________________

City:________________________  State:________  Zip:___________ 

Email:____________________________________________________

Book Special: Buy Three, Get Two Free

Products
Book $13	Qty:                  x $13	Book Total:
Book Special $39	Qty:                  x $39	Special Total:
VHS Video $20	Qty:                  x $20	Video Total:
Cassette $20	Qty:                  x $20	Cassette Total:
Book, Video, and Cassette $50	Qty:                  x $50	Combo Total:
Shipping $5.00 for first two items	Qty:                  x $5.00	Shipping Total:
Shipping each additional item $3.00	Qty:                  x $3.00	Additional Shipping:
		Grand Total:

Classes, Retreats, Seminars, Teacher Certification
Private Sessions     Bend, Oregon     Your Town	$100. per hour per person
Private Retreats     Bend, Oregon     Your Town	Call for details
Private Seminars     Bend, Oregon     Your Town	$100. per hour per person ($300. minimum)
Teacher Certification Level I, Level II     Bend, Oregon     Your Town	Level I - $3000. per person (two people required)    Level II - Call for Details

Gifts Certificates Are Available in any Denomination

Name of Sender: _{____________________________________}

Amount of Gift: ______________________________

Occasion: ___________________________________

Name of Recipient: ____________________________

Mailing Address: ______________________________

City, State, Zip: ______________________________