DIMITRI KOPANAKIS – ‘This is the Moment’

ORDER FORM

$25AUD (includes postage and handling)

Please send me __________ copy / copies of ‘This is the Moment’.

I have enclosed my cheque or money order for $__________ Australian dollars.

Name: _________________________________________________________

Address: _______________________________________________________

_______________________________________________________________

_______________________________________________________________

Email address: ___________________________________________________

I do / do not require a receipt (please circle)

I would / would not like to be kept informed of upcoming performances and

events (please circle)

Please post this form along with your cheque or money order to:

PO Box 3689

South Brisbane BC

Qld 4101