Use this form to order directly from Gem-Systems
Order Form
for Books and Tapes

I would like to order the following VHS Videos, Computer Video CD's, CD's Books or Tapes:
(Please click on all you would like to purchase)

QUANTITY	TITLE	COST*	MEDIA
	Hyper Performance: The AIM Strategy for Releasing Your Business Potential (Hard cover presently out-of-print, available in spiral-bound.	$35.00 $5.00/shipping	Book
	Hyper Performance: The AIM Strategy for Releasing Your Business Potential IN ITALIAN	$35.00 $5.00/shipping	Book
	A Clinical Hypnosis Primer	$135.00 $5.00/shipping	Book
audio    CD	Rx for Stress - NEW on CD!	$20.00 $5.00/shipping	Audio Cassette CD
	Release Your Business Potential Using the A.I.M. Strategy to Become a Hyper-Performer	$25.00 $5.00/shipping	Audio Cassette
	Clinical Hypnosis: Techniques and Applications	$85.00 $5.00/shipping	Video Tape
DVD Video    CD	Emotional Self-Management Training Video - Tape 1 NEW on DVD and Computer CD Video!	$49.95 $5.00/shipping	DVD Video Tape Computer Video CD

*all prices are in US$

SHIPPING INFORMATION:

Shipping charges are a flat rate of $5.00 per item.

SALES TAX

Items shipped to California addresses will be charged 7.75% sales tax

SHIP TO:
SHIP TO ADDRESS:
SHIP TO CITY:
SHIP TO STATE/ PROVINCE:
SHIP TO POSTAL CODE:
SHIP TO COUNTRY:

YOUR INFORMATION:
(all information required)

YOUR NAME:
YOUR PHONE NUMBER (WITH AREA CODE: )
YOUR EMAIL ADDRESS:

PAYMENT INFORMATION
I will pay by: credit card check (see directions)

CREDIT CARD INFORMATION

NAME ON CARD:
CARD NUMBER:
EXPIRATION DATE:

Print out this form and fax your credit card order to: 1(858)452-7610

CARD TYPE: VISA MASTERCARD AMERICAN EXPRESS
NOTE: ALL CREDIT CARDS WILL BE VERIFIED BEFORE PRODUCTS ARE SHIPPED

TO PAY BY CHECK:

PLEASE PRINT THIS FORM OUT AND SEND IT WITH YOUR CHECK TO:

Peter T. Lambrou, Ph.D.
George J. Pratt, Ph.D.
Scripps Memorial Hospital Campus
9834 Genesee Avenue, Suite 321
La Jolla, CA 92037

Make check payable to Drs. Lambrou & Pratt

THANK YOU FOR YOUR ORDER

TO COMPLETE THIS ORDER, CLICK THE SUBMIT BUTTON