Team Spirit Order Form

Complete this form and mail to:

Or fax the form to:

Or phone a credit card order to:

 

 

 

Math Olympiads

 

 

ATTN: Publications Department

2154 Bellmore Ave

(516)785-6640

(866)781-2411

Bellmore, NY 11710-5645

 

 

Check (payable to MOEMS) Number_____ is enclosed.

Or Purchase Order Number ______ is enclosed.

Or Credit Card:            q MasterCard        q VISA         q Discover           q American Express

 # _____   _____   _____   _____    Expires _____

Item Size Quantity Domestic Unit Price Foreign Unit Price TOTAL PRICE
T-SHIRT Small  
@ $10.00
@ $12.00
 $
T-SHIRT Medium  
@ $10.00
@ $12.00
 $
T-SHIRT Large  
@ $10.00
@ $12.00
 $
T-SHIRT X-Large  
@ $10.00
@ $12.00
 $
Cap    
@ $6.00
@ $8.00
 $
Pennant    
@ $1.50
@ $2.00
 $
        TOTAL $
  Mail to:   
  Name _____________________________ School_______________________________
  School Address _____________________ City/State/ZIP _________________________
  Country ___________________________ Telephone ____________________________
  Billing Address, ____________________________
   if different from Mailing Address:  ____________________________
    ____________________________