A nonprofit, scientific, educational, membership, corporation |
PO Box 707 Malaga NJ 08328 USA (856) 692-4686 . . . . . . . dinshahhealth@aol.com |
(Mr, Ms, etc.)_________ ______________________________ Gender_______ Birth Year 19____
Title Name
Address_________________________________________________________ Apt #_________
City, State, Zip_______________________________________________________________
I learned of this Society from_________________________________________________
Occupation_______________________________________ Phone #______________________
My local Only for foreign o North o East
time zone________ Countries: I live______km o South o West __________________
of this large city
Comments_________________________________________________________________________
_________________________________________________________________________
Membership to end of year (or following year if after Sept. 30), $3.00 ($6 = 2 years, $9 = 3years).
Includes Forecast times, and Newsletters when published, usually four per year.
>
Date_____________________________ Signed________________________________________
#1: Spectro-Chrome Information Package: items A, F, N (DVD) | @ $20________ |
#2: Spectro-Chrome Information Package: items F, N (DVD) and please specify the language of the book, I German _____, X Chinese ____, or Y Spanish _____. | @ $20________ |
#3: Add to price of an Info Package if item M is also desired. | @ $12________ |
#4: Add to price of an Info Package if item P is also desired. | @ $17________ |
#5: Add to price of an Info Package if item S is also desired. | @ $4________ |
#6: Add to price of an Info Package if item W is also desired. | @ $6________ |