NDRN MERCHANDISE

ORDER FORM

To order NDRN Merchandise, please complete this form and return it to:

NDRN

900 Second Street, N.E., Suite 211

Washington, DC 20002

Tel: (202) 408-9514 Fax: (202) 408-9520 E-Mail: info@ndrn.org

ALL ORDERS MUST BE PREPAID

______________________________________________________________________________

Quantity /Amount

VOTING TEE SHIRTS…….$17 (S, M, L, XL, XXL, XXXL)

PANDAS . . . . . . . . . ………..$5 / $8 / $10 _______ /_______

TRAVEL MUGS……………$9

TEE SHIRTS: GREEN…..$15 (L, XL)

PLUM……$15 (L, XL, XXL)

TOTAL ________ /__________

NAME____________________________________________________________________

ADDRESS_________________________________________________________________

__________________________________________________________________________

CITY____________________________STATE________________________ZIP________

TELEPHONE______________________________________________________________

Discounts available for bulk orders (10 or more)

For Credit Card Payments, please fill in the following information:

Type of Credit Card (Please check one)

[ ] MasterCard

[ ] Visa

[ ] American Express

Please type or print clearly:

Name on Card___________________________________________________________

Account #__________________________________Expiration Date________________

Zip Code (associated with this card)__________________________________________

Signature of Card Holder___________________________________________________

Amount to be charged:_____________________________________________________