Sherri Henderson (Sales Rep.)

Order DVD I would like to receive a copy of the "Pura Vida DVD on Costa Rica" PURA VIDA DVD ON COSTA RICA Contact Name: Company Name (opt): Phone Number: ########## (No Spaces in Phone No.) Email Address: Street: City: Country: Canada United States United Kingdom Australia Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia/Herzegowina Botswana Bouvet Island Brazil British Ind Ocean Ter Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Congo Democratic Rep Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Czechoslovakia Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France France Metropolitan French Guiana French Polynesia French Southern Ter Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Heard And McDonald Is Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Dem People's Rep Korea Republic Kuwait Kyrgyzstan Lao People's Dem Rep Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova, Republic Of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent/Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leones Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia/S Sandwich Is Spain Sri Lanka St Helena St Pierre and Miquelon Sudan Suriname Svalbard/Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Province of China Tajikistan Tanzania United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu US Minor Outlying Is Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Virgin Islands British Virgin Islands US Wallis/Futuna Islands Western Sahara Yemen Yemen Democratic Yugoslavia Zaire Zambia Zimbabwe Province/State: Pick One None Alabama Alaska Arizona Arkansas Armed Forces Americas Armed Forces Other (AE) Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Australia --------- Australian Capital Terr. New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Canada ------ Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Postal Code: Number of DVDs:

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