Please enter the information below, to send with your check.

               COPDers     Others
DVD 1      $15.00       $20.00                      QTY______       TOTAL__________
DVD 2      $20.00       $25.00                      QTY______       TOTAL__________
Shipping Per DVD        $3, $8 non-U.S.       QTY______       TOTAL__________
                                                            GRAND TOTAL____________

Other discounts: no shipping for NECA members and a 10-percent discount for a purchase of 4 or more DVDs.

( )Make check payable to Vijai Sharma, PH.D
( )Credit card: Visa__ Master Card___ card #_______________________________________

Name as it appears on the card: ____________________________Expires_________________

Signatures (required)________________________________ Date___________________

Please clearly print the following information so that we can get your product delivered reliably:

Purchaser's Name:__________________________________________Phone # _______________

Address: ______________________________________

City _______________________________ State ________________ Zip _________________

Email Address: ___________________________________________________

Please verify that the information you entered is correct.  Please print this page on your printer and then enclose it in an envelope with your check for the payment amount (made out to "Dr. Vijai Sharma")   and send to:

Vijai Sharma
4167 Balfour Ave
Oakland CA 94610

When we receive your check, we will confirm receipt.

And that's it!  We're done. Thank you!

If you need to contact me, use the info below:
Phone: (423) 476-1933
fax: (423) 476-3534
e-mail: dr.sharma@mindpub.com
Website: www.mindpub.com

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