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Show your support at the memory walk by ordering the Memory Walking Pin at $3.00 each. Add 9% tax and $1.00 for shipping.


Name: ___________________________________        Telephone: ______________________________

Address: _________________________________

City: ____________________________________

State: __________________  ZIP _____________        Email: __________________________________

Method of Payment:
____ MC    ___ Visa   ___AMEX

_______________________________ credit card number   ____ 3 digit number on back of card

_______________________________ signature


Fax order form to 318-619-8339.