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Name:______________________________________

Address:___________________________________

City:______________________________________

State:_____Zip:____________Country:________

Home Phone:________________________________

Business Phone:____________________________

FAX/E-mail:________________________________

Chan Mi Gong Video $39.95 each

Total Number of videos   _________x $39.95 Total $_________

CA residents add $8.25% ($3.30 each)$_________

          Shipping and handling $4.00, add’l Item $2.00 $_________

                                                                                Total $_________

Send Check or money order to :

Xian Tian Center

468 Pamela Court

Hayward, CA 94541