ORDER FORM

To Order Tape, CD, or Jungle Golf Game:
Print this page and fill in blanks on form
Attach check or money order for full amount
Mail to: DR. DENISE T. SILBERT
PO BOX 82993
SAN DIEGO, CA 92138-2993

NAME:

ADDRESS:

CITY:STATE:ZIP:

TELEPHONEE-MAIL

QTY
DESCRIPTION
PRICE
TOTAL
______ Golf Hypnosis For Success CD
$20.00
$____________
______ Golf Hypnosis for Success Tape
$15.00
$____________
______ Jungle Golf Game 
$17.95
$____________
Subtotal $____________
Shipping & Handling Per CD
Shipping & Handling Per Tape
Shipping & Handling Per Game
$2.00
$1.50
$3.00
$____________
$____________
$____________
Total $____________

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