Order Form

WORKSHOP REGISTRATION FORM
First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Home Phone:
Home E-mail Address:
Health Club:
Job Title:
Club Address:
City:
State:
Zip Code:
Business E-mail:
Would you like to include your e-mail address for new music and video releases?		YES, include my home e-mail address. YES, include my work e-mail address. NO, do not include my e-mail address.
Please list items that you are ordering. Clearly state item CD or video (cassettes are now special order only unless a special offer) and BPMs if applicable.
Method of Payment:		MC VISA Check Electronic Check
MC/Visa use PayPal (see below) or call 603-659-7288 to leave number.
Number of items at $25 each:		Total dollar amount: $
Number of items at $15 each:		Total dollar amount: $
Number of VIDEOS at $15/$25:		Total dollar amount: $
Total number of items:		Shipping amount: $
GRAND TOTAL amount due:		$

For MC/VISA (secured site) Electronic Check payments click here: PAYPAL sabrina@sabrinasvard.com		Personal Checks Mail to: 21ST CENTURY FITNESS 7L Piscassic Street Newmarket, NH 03857 (603)659-7288 FAX:(603)659-5134


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ORDER FORM