Sarasota Medical & Sports Hypnosis Institute 

Enter the date of ... :

-- mm/dd/yy

Please provide the following  billing information.  If the shipping address is different from the credit card billing address, please list the shipping address at the bottom of this form.  The following name & address is for credit card validation.

            Name 
           Title 
  Street Address 
 Address (cont.) 
            City 
  State/Province 
 Zip/Postal Code 
         Country 
      Work Phone 
      Home Phone 
             FAX 
          E-mail 

Please provide the following ordering information.  Some  programs have numbers & names.  Please utilize either or both.  Please indicate if you prefer CD format or audio cassette.

QTY     DESCRIPTION or NUMBER 
        Please mention if you prefer
        CD or mp3 Format

 
 
 
 
 
 
 
 
 
 
 
 

BILLING IS THROUGH PAYPAL ONLY. YOU CAN UTILIZE
ANY CREDIT CARD WITH THIS SERVICE.
     
 

                 SHIPPING ( if different from above )
  Street Address 
 Address (cont.) 
            City 
  State/Province 
 Zip/Postal Code 
         Country 

Comments or questions?  THE CONFIRM PAGE LINK ISN'T WORKING, SO PLEASE SEND ME YOUR ORDER BY EMAIL UNTIL THIS IS FIXED.  THANKS SO MUCH.

Once I have your secure order, I will send you an email confirmation.  No orders are filled before the confirmation is sent.   You might like to make a copy of your order before submitting the form to my desk.