TO ORDER BY FAX OR MAIL PLEASE PRINT OUT THIS FORM

FAX OR MAIL ORDER FORM FOR 
THE GESTALT EXPERIENTIAL TRAINING PROGRAM (G.E.T.)

We do not accept telephone orders 


Name

Address

City                                             State/Province                                                        Zip/Postal Code
Country

Email Address


______   Individual Version – DVD & One Copy of Quality Edition of Manual – $95.00
                                                (not for use in group or academic settings)

_____  Training Version – DVD & One Quality and Ten Copies of Classroom Edition of Manual – $175.00


______   Ten Additional Copies of Classroom Edition of Manual – $20.00
                 (may be ordered only with order for training version) (order in multiples of ten copies)

______   Single Copies of Quality Edition of Manual – $20.00

______    Amount to charge my credit card or check enclosed
            (checks must be payable in US funds and drawn against US banks)

Visa/Master Card/American Express Card #                                                           Expiration Date

Fax this form to: 1-866-460-8795

Mail this form to:       The Gestalt Journal Press
                                            P. O. Box 278
                                            Gouldsboro ME  04607-0278
                                             U.S.A.

Sorry -- no telephone orders