Postal Mail Order Form                                       03    03         ...

03

Print this page and send your donation to 

The Life Center         8335 Winnetka Ave.,  #107        Canoga Park, CA  91306

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Make your check or money order payable to The Life Center

If you send cash, we cannot guarantee its safety during delivery.  

Mail to:

The Life Center       

8335 Winnetka Ave.,  #107      

Canoga Park, CA  91306

Please print Clearly

Your Name:_______________________________________________

Mailing Address:___________________________________________

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E-mail Address:  __________________________________________

Phone Number:  ___________________________________________

Whom do you know that we should contact regarding our work?

Their Name:______________________________________________

Mailing Address: __________________________________________

City:_____________________ State:___________ Zip:__________

Their E-mail Address: ______________________________________

Can we say that you referred them to us  _____ YES  _____ NO.

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Please share your thoughts and opinions with us.

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