PREFER TO ORDER ONLINE? USE OUR SECURE ORDER FORM.

Or, complete this form, and get it to us by...

1. Fax complete this form and fax it to 973-736-3930 with your Visa or Mastercard information and signature.

2. Phone call 1-973-736-1304. Give us all the information below.

3. Mail a check with the completed enrollment form to:
Axelrod Learning o 14 Seaman Road o West Orange, NJ 07052

4. Email the information: USE OUR SECURE SERVER

Name _____________________________________________________________________

Address ___________________________________________________________________

City ________________________________ State _____________ Zip _________________

Day Phone _________________________________________________________________

Eve Phone _________________________________________________________________

Fax # _____________________________________________________________________

Email _____________________________________________________________________

Yes, please register me for ______ Value Profile(s) and complete reports for ONLY $99 each (plus $3 to ship and handle), for a total of $102 for each profile ordered (add $13 to ship outside the U.S. - a total of $115).

Special Teenage Offer:
Yes, I'd like to also register ______ teenagers for the Personal Pathfinder Profile for each Personal Value Profile I order for only $50 each (plus $3 to ship and handle), a total of $53 ($63 to ship outside

Yes, register me for the next telephone Mastermind Coaching Group.
To find out more, read about Mastermind Coaching.

______ Here's my check for $ ___________ payable to Axelrod & Associates.

______ Please bill $ ____________ to my Visa or MasterCard (circle one)

Card # __ __ __ __ / __ __ __ __ / __ __ __ __ / __ __ __ __

Expires ___/___ Signature ______________________________________________________

We thank you for your confidence and commit our support to your success!

Submit this order form.

Then proceed to complete your Value Profile.