VISION MOUNTAIN TRAINING INC.

P.O. BOX 479, NELSON, B.C. V1L 5R3 CANADA

E-mail: visionmountain@shaw.ca

Toll-free Phone/Fax: 1-800-337-0009 Phone/Fax: 250-825-0009

PERSONAL INFORMATION FORM

Please check one:

I am placing an order (order form included) I would like to register for a Workshop or Leadership Training

Please write in name and date of event: YOUR NAME: ADDRESS: CITY: PROV./STATE: POSTAL/ZIP CODE: COUNTRY: PHONE/FAX: E-MAIL:

Would you like to be on our mailing list? Yes No

Please check one:

Here is my money order Credit card information

Put a check mark by the credit card you are using: VISA MASTERCARD AMERICAN EXPRESS

PLEASE PRINT CLEARLY IF YOU ARE USING A CREDIT CARD

1. Your name exactly the way it is written on your card (including initials). 2. Credit card number: 3. Expiry date: Month Year

Please phone/fax or mail this information to us. Be sure to include your order form (below) if you are ordering books, tapes or the Vision Card CD.

ORDER FORM

ALL PRICES IN US DOLLARS     (all prices include GST and sales tax) Quantity Price VISION CARD CD     (available in six months; currently taking orders only) BOOKS     The Power of the Gift $10.00 TAPES     All tapes $7.50 (currently out of stock)     Winning the War of Independence Relationships: From Grievances to Gratitude Sex with Heart and Soul TOTAL COST OF ORDER (not including S&H) $USD

Shipping and Handling Charges:     To Canada $2.25 Manitoba (east) $3.80     To USA $4.00     To UK $4.25     To Europe $4.50     To Asia $5.25     Other $5.50       Shipping and Handling $USD TOTAL MONEY ORDER OR CREDIT CARD CHARGE $USD

Please print this form and fax or snail mail it to: P.O. BOX 479, NELSON, B.C. V1L 5R3 CANADA Toll-free Phone/Fax: 1-800-337-0009 Phone/Fax: 250-825-0009

BE SURE TO INCLUDE PERSONAL INFO FORM WITH ORDER