Fax / Mail Order Form
More comfortable ordering/registering without the internet?
The form below can be printed out and sent to us via mail or fax.
To
register for Healing From the Core classes, please see the individual
registration instructions for each class click
here |
To
register for Continuum & the Healing Process classes, please fill
out the form below and send/fax to the HFC office. |
MAILING ADDRESS:
Suzanne Scurlock-Durana
11417 Tanbark Drive, Reston, VA 20191
703-620-4509 (phone)
703-620-4504 (fax)
Quantity |
Audio Series
Name |
Format |
Cost |
Amount Enclosed |
|
CD |
$99 |
|
||
| Healing
from the Core 3-Session Mini-Series |
CD |
$39 |
|
|
|
The Five Principles of Living Joyfully
|
CD |
$18 |
|
|
|
Basic Relaxation and Energizing Exercise
|
Cassette |
$10 |
|
|
|
Basic Relaxation and Energizing Exercise
|
CD |
$18 |
|
|
|
2 CDs |
$35 |
|
||
|
DVD |
$300 |
|
||
|
DVD |
$240 |
|
||
|
DVD |
$270 |
|
||
|
2003 Continuum & The Healing Process: Optimum Brain Function |
DVD |
$240 |
|
|
|
DVD |
$300 |
|
||
|
DVD |
$300 |
|
||
|
2006 Continuum and The Healing Process: Essence of the Heart |
DVD |
$300 |
|
|
|
DVD |
$300 |
|
||
| Virginia residents add 5% tax | ||||
| Shipping
- Audio Series $7 first set, $4 each additional item Continuum & Healing (DVD) $14, $5 each additional item |
||||
| Audio/Video Total | ||||
| Continuum Seminars | Dates |
Price |
Total |
| "Continuum
and the Healing Process: The Undiscovered Body" Reston, Virginia (30 CEU contact hours) |
Oct. 24 - 28, 2008 |
$795 |
|
Seminar
Total |
|||
|
GRAND TOTAL: $____________________
|
| Billing Details | |||||||||
| I will be paying by: | |||||||||
| check | VISA | MasterCard | American Express | Discover | |||||
| Credit Card No: | |||||||||
| Card Verification Number:
[The verification number is a 3-digit number printed on the back of your card. It appears after and to the right of your card number. If you are using American Express, the verification number is a 4-digit number printed on the front of your card. It appears after and to the right of your card number.] |
Expiration Date mm/yy: | ||||||||
| Please charge my payment of $ . | |||||||||
Signature (if paying by credit card) |
|
||||||||
| Billing Information (enter the following exactly as it appears on your credit card statement) | |||||||
| Name | |||||||
| Address | |||||||
| City | State | Zip | Country | ||||
| Phone(day) | Phone(eve) | ||||||
| Shipping Address: | |||||||
| HAND CARRIED from class (no need to ship) | |||||||
| PLEASE SHIP -- Not available at class | |||||||
| Use the above billing address as the shipping address | |||||||
| DIFFERENT SHIPPING address below | |||||||
| Name | |||||||
| Address | |||||||
| City | State | Zip | Country | ||||