OSPA
STORE - ORDER FORM
(please print and complete form)
|
PATCHES |
QUANTITY REQUESTED |
$3.00 EACH |
TOTAL COST |
|
|
First Responder |
|
|
$ |
|
|
EMT-Basic |
|
|
$ |
|
|
EMT-Intermediate |
|
|
$ |
|
|
EMT-Paramedic |
|
|
$ |
|
|
TOTAL |
$ |
|||
|
T-SHIRT |
QUANTITY REQUESTED |
SIZE |
$15 EACH |
|
|
Red |
S |
$ |
||
|
= |
M |
$ |
||
|
= |
L |
$ |
||
|
= |
XL |
$ |
||
|
= |
XXL |
$ |
||
|
TOTAL |
$ |
|||
|
T-SHIRT |
QUANTITY REQUESTED |
SIZE |
$15 EACH |
|
|
Light Green |
S |
$ |
|
|
|
= |
M |
$ |
|
|
|
= |
L |
$ |
|
|
|
= |
XL |
$ |
|
|
|
= |
XXL |
$ |
|
|
|
TOTAL |
$ |
|||
|
T-SHIRT |
QUANTITY REQUESTED |
SIZE |
$15 EACH |
|
|
Darker Green |
S |
$ |
||
|
= |
M |
$ |
||
|
= |
L |
$ |
||
|
= |
XL |
$ |
||
|
= |
XXL |
$ |
||
|
TOTAL |
$ |
|||
|
T-SHIRT |
QUANTITY REQUESTED |
SIZE |
$15 EACH |
|
|
Light Blue |
S |
$ |
|
|
|
= |
M |
$ |
|
|
|
= |
L |
$ |
|
|
|
= |
XL |
$ |
|
|
|
= |
XXL |
$ |
|
|
|
TOTAL |
$ |
|||
|
|
|
|
|
|
|
T-SHIRT |
QUANTITY REQUESTED |
SIZE |
$15 EACH |
|
|
Special Edition "2002-On the Road to Redmond" |
S |
$ |
||
|
= |
M |
$ |
||
|
= |
L |
$ |
||
|
= |
XL |
$ |
||
|
= |
XXL |
$ |
|
|
|
TOTAL |
$ |
|||
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|
|
|
|
|
|
|
|
GRAND TOTAL: |
$ |
|
|
SHIP TO:
NAME: ___________________________________ ADDRESS: ________________________________ ________________________________
CITY: ___________________________________ STATE: _________________ ZIP: ____________ PHONE: __________________________________ E-MAIL: __________________________________
|
Mail this form, along with the proper payment, to:
O.S.P.A. P.O. Box 647 Albany, OR 97321 USA |