How to print this form: Click HERE to select this frame. Turn printer on and
select "Print " from the File menu.

Please select the quantity desired and shipping method:

Quantity	Item	Price	U.S. Priority Mail	International Priority
______	Healing Power Zones (Hour 1)	$38.95	[ ] $3.20	[ ] $18.60
______	Healing Power Zones (Hour 2)	$38.95	[ ] $3.20	[ ] $18.60
______	Package Set (both tapes)	$70.00	[ ] $6.40	[ ] $37.20

TAX: California residents please include 8.25% sales tax (excluding shipping charges).

Total Enclosed: ____________

____Check or Money Order (Please make check or money order payable to David Kearney)
____Bill my Credit Card: [ ] Visa [ ] Mastercard [ ] American Express
(sorry, we do not accept Discover or other cards at this time)

Card Number: _________________________________ Expiration Date: ___________

Name on Card:________________________________________________

Billing Address:________________________________________________

City, State, ZIP:________________________________________________________

Email Address or Fax Number for confirmation of order:__________________________________

SHIP TO:
Name (if different): ___________________________________________________________

Address (if different): _________________________________________________________

City, State, ZIP: ______________________________________________________________

Country (if outside the U.S.):____________________________________________________

How did you find Power Healing?

[ ] Search Engine (which one):___________________________

[ ] Link from another site:_____________________________

[ ] Other:________________________________

Fax this form (24 hours, 7 days a week) to (310) 453-8056 for credit card orders, or mail to:

Dr. David Kearney
1821 Wilshire Blvd. Suite 610
Santa Monica, CA 90403

Thanks for your order!