ORDER FORM

~~~~~~~~  2004 NMGCS COMMEMORATIVE  ~~~~~~~~

WHITE MILK GLASS BIRD WITH BERRY  ON SPLIT RIB BASE
[Use this form both for mail order and/or convention pickup]

(NOTE: orders are limited to 2 per single membership & 4 per joint membership)


    Quantity___________ x $30 each          =              $____________       (a)

    Will you pick up your order at the convention site?   Yes    No        (b)

    Add Shipping & Packing (for mail orders only) as follows:

    U.S. Orders: $8 for first piece & $5 for each additional piece
    shipped to the same address

- OR -


    International: $10 for the first piece & $5 for each additional piece
    shipped to the same address

           Mailing Cost        =          $____________  (c)

           TOTAL ORDER       =     $____________  (a) + (c)


MAKE CHECKS PAYABLE TO NMGCS


    Member Name_______________________________________________

    Address____________________________________________________

    ___________________________________________________________

    Telephone: (____)________________ E-mail: ______________________

       Send orders to Julie Campbell, 567 Robinson Avenue, Barberton, OH 44203.
       Questions? Contact Julie at (330) 745-3403 or E-Mail: 


       Note: Commemoratives will not be shipped out until after the convention.
       Anticipate receipt of your commemorative by the middle of July 2004.