QCWA Name Badge order Form
Call ________ Name: First ___________ Last _____________________
3rd Line Choice:
[ ] City _________________________________ State ________________
or
[ ] Chapter Name _________________________ # ______ Q # ________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Badge $ 8.00
Pocket Clip - $2.00 $__.00
or
Bola Ties - $2.50 $__.__
[ ] Black [ ] Blue [ ] Brown [ ] Green [ ] Red [ ] White
or
Magnetic Backing - $2.50 $__.__
Additional Postage for non-US delivery - $1.00 $__.00
Total Cost $___.__
Complete in full and mail with your payment to:
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