2010 FPRA-OAC Image Awards Reorder Form

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2010 FPRA-OAC Image Awards Reorder Form

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2010 FPRA-OAC Image Awards Reorder Form

  1. 1. 2010 IMAGE AWARDS RE-ORDER FORM Qty. Description Cost ea. Total Grand All Image Award Pyramid $96.25 Grand Image Award Pyramid $82.50 Image Award Or Grand All Image Award $40.70 9”x12” Walnut Plaque w/Silver Image Coin Logo Image Award, Grand Image Award, or Judges' Award 5"x7" $27.50 Walnut Plaque W/Laser Image Logo Award of Distinction Certificate in 10 1/2" x 13" Walnut frame $27.50 w/Plexiglas (printed-complete) Award of Distinction, Judges' Award, Image Award $5.75 Printed Certificate Only *Shipping – Add $6.00 per item for delivery Subtotal Allow 4-6 weeks for delivery Shipping Send check (payable to FPRA), or place your 7% sales tax credit card information below TOTAL Award Division/Category__________________________________________________________________ Title of Entry____________________________________________________________________________ Names on Award (limit 3) ______________________ _____________________ __________________ Shipping Address (No PO Boxes) _______________ City _______________ State_________ Zip______ Credit Card Billing Address (if different) ________________________________________ Zip ______ Name _____________ Name on Card (if different)____________________ Telephone _________________ Type of Card ____________ Credit Card # ___________________________ Exp. Date______ / ______ Security Code (Visa, MC, Discover- last three digits on back of card – AmEx-four digits on front) ____________________________ Signature: _____________________________________________________________________________ Mail, fax or email the completed form to Jennifer Gammage no later than Friday, May 21, 2010 at 4:00 PM: Jennifer Gammage st 2200 West 1 Street Sanford, FL 32771 Fax: (407) 321-3041 jgammage@cancercarecenter.md

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