THE GROUP ROOM® TAPE ORDER FORM
                          Previously Aired Programs

INSTRUCTIONS: 
Pour commander un programme enregistré sur bande, utilisez la touche "impression"  pour imprimer cette forme. Remplissez le formulaire, et expédiez-l'avec le contrôle payable aux Vital Options International à l'adresse suivante d'envoi.  Veuillez accorder 2 à 4 semaines pour la livraison.

              Vital Options International TeleSupport Cancer Network
                       4419 Coldwater Canyon Ave., Suite I
			  Studio City, CA  91604-1479
                                    USA


Emission #                   Quantité                          Prix
    
_______________               _____  @ $12.99 ea          _______________

_______________               _____  @ $12.99 ea          _______________

_______________               _____  @ $12.99 ea          _______________

                                                  TOTAL:  _______________


Veuillez envoyer la bande à :

Name:              ____________________________________________________________

Company:           ____________________________________________________________

Address:           ____________________________________________________________

City, State ZIP:   ____________________________________________________________

Phone/Fax:         ____________________________________________________________

Country:           ____________________________________________________________

Email (Optional):  ____________________________________________________________



Vital Options is a California 501 C(3) non-profit cancer support organization.
A portion of your check may be tax deductible in accordance with current tax laws.
Federal Identification #95-3899700.

Vital Options International TeleSupport Cancer Network
4419 Coldwater Canyon Ave., Suite I, Studio City, CA  91604-1479, USA
818-508-5657, Toll Free: 800-477-7666, Fax: 818-788-5260
http://vitaloptions.org