Inner Moves Centre ORDER FORM

Please complete the following form. Return by email if paying through Pay Pal to innermoves@sunshine.net or print out and return by surface mail along with your cheque or money order payable to Dhyana Bartkow.

mailing address: Dhyana Bartkow Inner Moves Centre for Body and Soul RR9 625 Glen Road, Gibsons, BC, Canada V0N 1V9

Class / Workshop / Retreat   for which you are registering: ____________________________________________________________ Date of class / workshop / retreat : ________________________ Cost : __________    Full Fee _________   or  Amount of Deposit __________    "Cancellation Policy: Deposit refundable 2 weeks prior to event, less a 10% administrative fee." Video / CD which your are ordering : _______________________________________ Cost : __________    Shipping _________    Total: _________    "Your product will be shipped promptly and the quality assured." Name : ____________________________________________________ Email Address : ____________________________________________ Mailing Address : ___________________________________________ City/Postal Code : _______________________________________ Phone:(______) __________________________ Birthdate: _______________________________________ Current Date : _______________________________________ Do you wish to be notified of future tapes and events? ________________ ____________________________________________________              signature

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