Please complete this form and print two copies. Keep one copy for your records and mail one copy to: IMOM - PO Box 181 - Pennsville, NJ 08070
Date:
Name:
Street address:
City, and state (or province) and zip:
Email: Phone:
Tee Shirts
How many? What size(s)?
I have enclosed a check or money order in US funds for the amount of: ($22 for sizes S, M, L and XL - $24 for XXL. Postage is included for ONE shirt. Please add an additional $.50 postage for each additional shirt)
Sweat Shirts
I have enclosed a check or money order in US funds for the amount of: ($26 for sizes S, M, L and XL - $28 for XXL. Postage is included for ONE shirt. Please add an additional $.50 postage for each additional shirt)