Video Lesson Order Form

Send this form and your video to:                               
Irina Yastrebova
P.O. Box 901                      
Smoky Lake, AB, T0A 3C0
Canada

Name _______________________________________________________________________

Address ____________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Phone number _______________________________________________________________

E-mail address _____________________________________________________________

Comments ___________________________________________________________________

Video Lesson ..................................................... $50.00(CAN)


     O  Check
     O  Money order          

Amount Enclosed: $