Integral Yoga® Magazine
Order Form
  1. Print this form in its entirety
  2. Fill in all information
  3. Make Check or Money Order payable to: SAYVA
  4. Make a copy for your records
  5. Fax the form with the credit card info to 434-969-1303 or mail it with your payment to:

    Integral Yoga Magazine, Dept. W.
    108 Yogaville Way
    Buckingham, VA 23921
Billing Address: (Please provide all contact information)


First Name:
Last Name:
Street:
City:
State:
Zip:
Country:
Email:
Phone:
Shipping Address (if different than above)


First Name:
Last Name:
Street:
City:
State:
Zip:
Country:
Payment Information


___  Check #______________________

___  Money Order #______________________


___  Visa / MC ________ - ________ - ________ - ________

       Exp. Date: _________

I would like to (Please indicate quantity below):


Subscribe

___  Two year subscription (USA) - $42.00
___  First Class Shipping - add $12.00/2yr.

___  One year subscription (USA) - $25.00
___  First Class Shipping - add $6.00/yr.

___  One year Subscription (Canada/Mexico) - $32.00

___  One year Subscription (All Other Countries) - $42.00

Order Individual copies of The Commemorative Issue

___  The Commemorative Issue (USA) - $10.00 (including shipping)
       (add $2.00 for shipping for each additional issue)

___  The Commemorative Issue (Canada/Mexico) - $17.00 (including shipping)
       (add $2.00 for shipping for each additional issue)


___  The Commemorative Issue (International) - $21.00 (including shipping)
       (add $5.00 for shipping for each additional issue)
Order Individual Issues

___  (Please indicate the name/date of the issue) _____________________________
        USA or International - $10.00 (including shipping)
Become a Personal Donor:

___  Sponsor - $108.00/yr

___  Supporter - $250.00/yr

___  Patron - $500/yr

___  Sustainer - $1,008/yr

___  Benefactor's Photo Album - $1,008/per issue

For sponsors, supporters, patrons, and sustainers
please note how you would like to see your name appear:
(example: Mr. & Mrs. John Doe, Ms. Jane Doe, etc.)

_________________________________________________________

Benefactors Photo Album: we will contact you for specifics regarding your pages.
Become a Business Donor

___  1/8 Page (Business Card) - $150.00/yr

___  1/4 Page - $250.00/yr

___  1/2 Page - $350.00/yr

We will contact you for specifics regarding your pages.
Order the 2007 Wall Calendar

___  USA - $10.00 (including shipping. add $2.00 for each addit. copy)

___  Canada & Mexico - $10.00 (including shipping. add $3.00 for each addit. copy)

___  Other Countries - $15.00 (including shipping. add $3.00 for each addit. copy)
Special Notes:


Signature:__________________________   Date:______________