To register your copy of the Brain Dancing Coach, print this page, fill out the order form, and send it along with a check for $42 ($39 plus $3 shipping) to the following address:

BrainDance.com
1075 Bellevue Way NE, #161
Bellevue, WA 98004

If you register before 4/30/97, the registration fee is $32 ($39 plus $3 shipping).

Name: _______________________________________

Company: _______________________________________

Shipping Address: _______________________________________

_______________________________________

City: __________________ ST: ______ Zip: ______

Email Address: ________________________

How did you hear about the Brain Dancing Coach.

For more information, refer to the Brain Dancing Online website, http://BrainDance.com