Healer-Calendar Order Form

With a $200 donation to the Daisy Institute, you will expeditiously receive the Healer-Calendar anywhere in the globe by air-mail, wherever public mail can reach.

Simply fill out the form here, in clear letters, and send it, along with your donation, to the Daisy Institute address below here:

Daisy Institute
6525 Wilderton Ave. Suite 710
Montreal, Qc. H3S 2L4  Canada

E-mail: daisyinstitute@daisyinstitute.com
tel. (514) 733-2408

Family Name:__________________________Given Name:_______________
Street Address:_________________________________________________
________________________________________________Apt.#___________
Town/City:______________________________________________________
State/County/Prov.:_____________________________________________
Country:_______________________________Postal/ZIP Code:_________
Date____________________________________________________________

Check the appropriate box with your donation for one or more Healer-Calendars:

One Calendar
$200		 Two
$300		 Three
$400		 Four
$500		 Five
$610

The Healer-Calendar also makes an excellent gift.