Name :   ______________________________

Handle : ______________________________

Street Address : _____________________________________

City : ___________________________________ 

State : _________ 

Zip : ___________

E-Mail Address (in case we need to contact you quickly): ___________________________

or

Phone Number (if you don't check e-mail often): _______________


Shirt Size : ____________ (S, M, L, XL)
(there will be an additional charge of $1.00 for each shirt over XL, IE : XXL is an add'l $1.00 XXXL is an add'l $2.00)

Number of shirts : ________

NOTE : Shirts will be $10.00 (S, M, L, XL) and that includes shipping and handling, add $1.00 for each added size increase.

Make checks or money orders payable to : 

Beth Bock
PO Box 607
Attleboro, MA  02703