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Printed Name (Dr., Mr., Mrs., Ms.)_______________________________________
Home Address ________________________________ City _________________
State _____ Zip __________ Country ___________
Academic Institution/Business __________________________________________
Position ________________________________
Address ____________________________________________ City __________ State
_____ Zip _____ Country ________
Home Phone _________________ Institution/Business Phone__________________
Fax Number _________________ Email_________________________________
__Add my name to the newsletter mailing list.
__Include me in future electronic mail notices.
__Include me in future invitations to academic/professional conferences
and special events.
__Send me a copy of Naturalism. I enclose $3 (USD) shipping/handling
only*.
__Send me the video / audio for lectures as follows:
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Presenter
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Item Price
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$Total
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I have enclosed $__________* (USD)
*Please include additional $3.00 per item shipping/handling if delivered
outside of USA.
Or charge my credit card: __MasterCard __Visa __American Express
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Card owner name (Please Print exactly as shown) _____________________________
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Card Verification Number** ___________
(**the 3- or 4-digit number on the back of most cards following the card
number itself)
I authorize this charge to my bank card:
Card owner signature _______________________________
Please make checks payable to Canyon Institute for Advanced Studies.
USD only, please.
Mail your request to:
Canyon Institute for Advanced Studies
Grand Canyon University
3300 West Camelback Road
Phoenix, Arizona 85017 USA
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