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First Name

Last Name

Email Address

Organization

Number of Licenses Needed?

How many in your organization or school would need access to this material annually?

Country of origin?

If undisclosed for security purposes, what general region are you located?

If internet security is a concern, are you able to receive secure hard drives through a trusted 3rd party source? Please explain.

Would you like to add "The Insanity of God" paperback to each license for an additional fee ($10 per book)?

Yes

No

Do you need an accompanying syllabus for this training material?

Yes

No

Custom Licensing Quote