StartGen 3.0 Registration Form

You can register your copy of StartGen by calling (800) 718-8901 or by filling out and faxing the form below to (425) 455-1066 (credit card orders only), You may also print the completed form and mail it (with check enclosed if paying by check) to:

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

Your Name:
Your Company:
Email Addr:
Address:
Address2:
City: State:
Zip: Country:

Check if this is an international order.

Card type:
Name as spelled on credit card:
Credit card number:
Expiration date:

Catalog Item QtyUnit Price
StartGen Registration $29
Brain Dancing Book $14.95*
Brain Dancing T-shirt $14.95*
Brain Dancing Audiotape     $14.95
Subtotal $
8.3% Sales Tax (WA residents only) $
Shipping $
Total Due $

* This is a special price only available if item is purchased at the same time you register StartGen. The regular prices are $19.95 for the book and $19.95 for the T-shirt.

Shipping charges are calculated as follows: Domestic orders: $4 for first item and $1 for each additional item (There are no shipping charges for StartGen). International orders: $15 for first item and $3 for each additional item.

You will be able to register online at some point. Click here to see if this service is available.