The Long Distance Course is $450.00. We do not charge for any of the ongoing counseling offered by the Director or by our nutritional counselors. We are here to help you through your program by phone and email for as long as you need our help. This involves hours of our time that we willing offer for free in order to help encourage you and answer all your questions and concerns. We offer a code letter with the applicable CPT codes to anyone considering enrollment; this has helped some obtain some insurance coverage.
Price outside the U.S. price is $450.00 (U.S. funds) plus postage, handling, & insurance.
You may also order a copy of the Clinic Cookbook at this time. If you would like to also order this item, fill in the number of copies desired in the space provided. Please mark with an "X" infront of the products you are requesting. Thank you.
________I would like to order one S.T.R.C Long Distance Course at $450
(Check one) For the video, I use format _________VHS
________I would also like to order _____ copy (s) of the Clinic cookbook, Come & Dine at $15.00 each plus $3.00 postage, for a total of $18.00 each. (higher applicable postage for orders outside the U.S.)
Name:____________________________________________________________________________
Postal address:_____________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
State____________Zip_____________Country___________________________________________
Email:____________________________________________________________________________
Phone number:(________)____________________________________________________________
Payment method:
____Cashier’s Check ______Money Order ____Personal Check _______Credit Card
Check correct Card: (Please print very clearly)
MasterCard __________Visa __________
Card number________________________________________________________________________
Exp.Date _____/_______
Name on card (printed)_________________________________________________________________
Signature (required, except by email)_________________________________________________________
If paying by personal check, the check will have to clear before the Course can be mailed.
No refunds will be issued for courses ordered.
MAIL THIS FORM TO: S.T.R.C., Inc.
FAX to (505) 424-3994 or EMAIL: stclinic@comcast.net your completed information.
Thank you. We look forward to working with you!
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