-PLEASE CLEARLY PRINT ALL INFORMATION-
FIRST NAME___________________________ LAST NAME ___________________________
STREET ADDRESS________________________________________________ APT._______
SHIPPING ADDRESS_________________________________________________________
CITY _____________________________________STATE____ ZIP CODE ______________
PHONE (_____)___________________ E-MAIL __________________________________
$12.00 ea. (XL,XXL, XXXL) | ||||
| x | x | x | x | x |
| x | x | x | x | x |
| x | x | x | x | x |
| x | x | x | x | x |
| x | x | x | x | x |
SUBTOTAL | x | |||
S - M - L - XL - XXL - XXXL | SHIPPING $5 each Book $3.50 each T-shirt | x | ||
MI TAX (6%) | x | |||
TOTAL | x |
Enclose your check or money order payable to:
Dr. Glen Maiden
Mail your check or money order to:
Dumbell Greek/Dr. Glen Maiden
North
Coast Family Fellowship
2245 North Wahanna Road
Seaside, OR 97138
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