please print out this form and send it with check or money order to:

Kathleen P. Lacey, M.S., L.C.S.W.
Stress Management and Mental Health Clinic ~ Suite 102
5225 N. Ironwood Road
Glendale, WI 53217

The price of the CD is $15. Postage and handling are $3.00.

Wisconsin residents please add your local county sales tax.