Video Order Form

Print out this form on your printer and mail to:

Please include MONEY ORDER made payable to"Combat Dynamics"

Hotel Radission TriesenbergMoney orders recieved, shipped same day.

If paying by personal check, allow 7 daysfor check to clear before shipment.

Name__________________________________________________

Address________________________________________________

City ________________________ State ______ Zip____________

	QTY	UNIT PRICE	TOTAL
KEMPO TRAINING MANUAL	____	$39.95	$________
KEMPO SELF DEFENSE & STREET COMBAT VOL.1	____	$39.95	$________
KEMPO WEAPONS DEFENSE	____	$39.95	$________
KEMPO BREAKHOLDS VOL.1	____	$39.95	$________
KEMPO SEMINAR LIVE FOOTAGE	____	$39.95	$________
INTRODUCTION TO JUN FAN JEET KUNE DO	____	$39.95	$________
Add $3.00 shipping and handling per video	____	$3.00	$________
TOTAL DUE:			$________