Helpful Products Order Form

If you are ordering the Physical Therapy Exercises for ST, it is available on VHS cassette and DVD disk. Please circle the format you would like to receive below.

VHS cassette       -      DVD disk

Members outside the USA, please add $5.00 to your order to help cover additional costs of postage.

Please send your check or money order made out to NSTA (sorry, but we are unable to accept credit cards):

National Spasmodic Torticollis Association
Orange Coast Memorial Medical Center
9920 Talbert Avenue
Fountain Valley, CA 92708

Enclosed is my check for $ ___________________

Name:       _______________________________________________________________

Address:    _______________________________________________________________

City:          _______________________   State: ____   Zip/Postal Code: _______________ 

Country:   ________________________________________________________________

Telephone:   ____________________________ 

E-Mail:  __________________________________________________________________

Please allow 4 to 6 weeks for delivery.

Thank you for your order!

Spreading Knowledge· Supporting Patients with ST· Encouraging Research