ORDER FORM - Please type or print clearly.

NAME____________________________________
_________________________________________

MAILING ADDRESS________________________
_________________________________________

Note: All WordMaps are in process. Only One and Two are available now.

PHONE (____) _____ - ________    Ext._______

I would like to make a tax
deductible donation of $__________

I am ordering:
(Circle Volume Number.)

Each Journal is $18-Three or more $15 each Exluding Vol. 1&2
The Full Set is $150 if available.

ENERGIS© WordMap: $27 suggested donation
to the Health Optimizing Institute.
                    Quantity:____

Cracking the Cult Code WordMap: $27 suggested
donation to the Health Optimizing Institute.
                    Quantity:____

All Seven WordMaps: $108 suggested donation
to the Health Optimizing Institute.
                    Quantity:____ sets.

TOTAL ENCLOSED  $___________

We accept payment by check, money order,
credit card (by phone), or C.O.D.
Make all checks or money orders payable to:

Health Optimizing Institute

If you have any questions, or to order by phone,
please call us between 9 a.m. and 5 p.m. Pacific
Standard Time at: (858) 481-7751