TONGUE-TIE VIDEO ORDER FORM
By ordering this video you agree to adhere to all applicable laws of copyright for this video and will not duplicate or copy it for any reason. You understand that doing so could result in federal prosecution.
Name
Institution
Mailing Address
Province or State	<Select> AL - Alabama AK - Alaska AS - American Samoa AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DE - Delaware DC - District of Columbia FL - Florida GA - Georgia GU - Guam HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MP - Mariana Islands MH - Marshall Islands MD - Maryland MA - Massachusetts MI - Michigan FM - Micronesia MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon PW - Palau PA - Pennsylvania PR - Puerto Rico RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VI - Virgin Islands VT - Vermont VA - Virginia WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming AB - Alberta BC - British Columbia MB - Manitoba NB - New Brunswick NF - Newfoundland NS - Nova Scotia NT - Northwest Territories ON - Ontario PE - Prince Edward Island QC - Quebec SK - Saskatchewan YT - Yukon NT - Nunavut Other, if outside Canada or USA:
Country	<Select> United States Canada Antigua Argentina Australia Austria Barbados Belgium Bermuda Brazil Chile China Colombia Croatia Cyprus Czech Repulic Denmark Dominican Republic Finland France Germany Greece Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Japan Malaysia Malta Mexico Netherlands New Zealand Norway Pakistan Peru Philippines Poland Portugal Russia Saudi Arabia Singapore Slovenia South Africa South Korea Spain Sweden Switzerland Taiwan Thailand Turkey United Arab Emirates United Kingdom Venezuela Other Country... Other country:
Phone/Fax #
e-mail address
Video or DVD Video and DVD Package Home use only $69.00 Home use only $99.00 With Public Performance Rights or institution $129.00 With Public Performance Rights or institution $139.00
Number of Videos	<Select> 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Price per video	<Select> $139.00 $129.00 $99.00 $69.00
Subtotal
Shipping & Handling	$9.00 for 1st video / $2.00 each additional
Total
Credit Card	<Select> Visa Mastercard
Credit Card Number
Expiry Date

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Fax your order to (403) 212-0733 or (403) 249-0156, the order form for the video is also available in Adobe Acrobat/PDF format.

<<GET THE ORDER FORM HERE>>

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