Stress Management and High Performance Clinic

Relaxation CD Order Form

From :

NAME ____________________________________________________________________

ADDRESS _________________________________________________________________

POSTAL CODE _____________________________________________________________

TELEPHONE _______________________________________________________________

E-MAIL ____________________________________________________________________

Each CD comes with TWO 30-minute relaxation techniques.

I wish to order :

(for every CD ordered, indicate which TWO of the following techniques you would like)

____ Progressive Muscle Relaxation - full body

____ Progressive Muscle Relaxation - shoulders, neck & face

____ Autogenic Training (to calm mind, body, emotions)

____ Alphagenic Relaxation (combines imagery and Autogenic Training)

____ Open Focus (brain training for mental flexibility & relaxation)

____ Power Hour (30 minute combination of the above techniques)

____ Bedtime Relaxation (bedtime combination of techniques)

____ Bedtime Progressive Muscle Relaxation

____ Bedtime Autogenic Training

Payment enclosed :

CD .......................................................................... @ $ 20.00 per CD $_____________

plus postage and mailing in Canada ........................... @ $ 1.50 per CD $_____________

( OR postage and mailing outside Canada ................. @ $ 2.50 per CD $_____________ )

................................................................................................Total due $_____________

Please make all cheques or money orders payable in Canadian dollars to the Stress Management Clinic.

If you have any additional questions regarding this order, please call the Stress Management and High Performance Clinic at 519 824-4120, ext. 52662, or e-mail ksomers@uoguelph.ca.

Thank you!

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