Origins Summit Media Order Form

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ORIGINS SUMMIT MEDIA ORDER FORM
April 1-2, 2011
Gladstone Park Conference Center

If you have any questions or problems with this form please contact
Krissy Barber at krissy.barber@oc.npuc.org


First

Last
 

Address 1

Address 2

City

State


Postal Code

Country
 

DVD COSTS  - $15 each DVD
                         OR $55 for the set

CD COSTS    - $55 (Sets of 8 only)
MP3 COSTS  - $50

Please note: Prices include packaging and postage.
US ADDRESSES ONLY

***To learn more about each time period and the speaker's topics please click here.***

Friday, April 1 - 7:00 pm - 9:00 pm
Saturday, April 2 - 9:00 am - 12:00 pm
Saturday, April 2 - 1:30 pm - 4:00 pm
Saturday, April 2 - 4:20 pm - 6:00 pm
Seminar Complete Set of 8 CDs
Seminar Complete MP3 Files
Visa, Mastercard, Discover, or American Express (Amex)
Check

PAYMENT DIRECTIONS:

For those paying by credit card:
Please call A & J Enterprises with credit card information following the completion of this form. Call 360-802-2033.

For those paying by check:
Please mail your check to:
A & J Enterprises
42717 188th Ave. SE
Enumclaw, WA 98022

Please note: Your order will not be shipped until your check has been recieved.

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