Order Form

To receive further information...

about any products or services we may offer at a later date, please fill out the form below. We value your trust and privacy and your personal information will not be given or sold to any third party without your consent.

Name

Your E-Mail Address

To Order by Mail:

  1. Print the form below.
  2. Completely fill out the form.
  3. Place the completed form in an envelopere along with your check or money order payable in the proper amount to "Dance of Independence".
  4. Mail to:
    Embracing the Dance of Independence
    136 E. 8th St. #213
    Port Angeles, WA 98362

Embracing the Dance Of Independence Order Form

Name:

Mailing Address:

City, State, Zip:

Day Phone:

Evening Phone:

Email address:

Please send me:

Quantity   Unit Price Total Price

 

x

US$49.95

 
  Shipping & Handling

US$ 5.00
  Total Order Amount

US$  

Privacy Policy: Your personal information will be used strictly for the purpose of providing the material or service ordered and will not be given or sold to any third party without your consent.

 

Copyright ©2003 Glenn Goldberg. All rights reserved.

Site design by Carolyn E. Cooper Communications.