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ORDER FORM

Quantity	Product	Price each
___________	Dysarthria Sampler (Videotape)	$19.95
_________	The Dysarthria Examination (Videotape)	$19.95
_________	Dysarthria Differential Diagnosis (Audiotape)	$9.95
_________	The Manual Laryngeal Muscle Tension Reduction Technique (Videotape)	$19.95
_________	The Psychosocial Interview (Videotape)	$19.95
_________	Puperphonia (Videotape)	$19.95
	Total Amount	____________

Minnesota residents add 6.5% sales tax; $3.00 shipping and handling; Canadian orders, add $3.00; Overseas orders add $15.00. 10% off on class orders of 10 or more units. Please add $15.00 for oversears orders.

Must prepay by check or money order! Mail form and check to:

Mentor Seminars, PO Box 1053, Rochester, MN 55903-1053 (telephone 507-289-0914)

Name:	___________________________________________________
Address:	___________________________________________________
City:	___________________	State:________	Zip:____________
Telephone:	(_____) ____________________________________________