Dianetics Auditing Request Form

Fill in the Dianetics Auditing Request Form and e-mail it to us.

Be sure to include both your e-mail and mailing address. We will assist you in finding an auditor in your area so you can begin right away.

Salutation:
First name:
Last name:
Address:
City :
State (US Only):

State/Province
(Non-US Only):
Country:
Zip/Postal code:
Phone (Home):
(Work):

E-mail: @

1) Would like more information about Dianetics? Yes No
2) Have you read Dianetics? Yes No

3) Have you seen the “How to Use Dianetics” video? Yes No

4) I am interested in finding an auditor in my area to start receiving Dianetics auditing. Yes No

5) I am interested in co-auditing Dianetics with a partner. Yes No

6) I would like to receive regular e-mailings about Dianetics and its availability in different parts of the world, local events, etc. Yes No

7) Please write here anything else you are interested in and want to let us know:

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© 2000-2004 Church of Scientology International. All Rights Reserved. For Trademark Information

© 2000-2004 Church of Scientology International. All Rights Reserved.
For Trademark Information