FFCA Commemorative 2004 Order Form
~ For FFCA Members Only ~

Membership #
Name

Mailing Address
City
State/Province	Zip/Postal Code
Home Phone

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TO ORDER:   select from the following 

Order Single  10th Anniversary Commemorative	Bronze Green	Price $40 $80 $40/each
Order Set of 3 10th Anniversary Commemorative	Bronze Green	Price $100 $200 $100/ 3 Set
Order Set of 4 10th Anniversary Commemorative	Bronze Green	Price $130 $260 $130/ 4 Set
Will Pick up at Reunion 2004		PLEASE SHIP (after October 2004)

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Shipping/Handling	TOTAL
Up to $50 = $3.85	Shipping/Handling
$51 to $100 = $7.85	TOTAL DUE
$101 to $260 = $9.85

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Method of Payment	Method of Payment Check Money Order Cashier Check Charge to my VISA Charge to my MasterCard
Check Number	Check Amount
	VISA       MasterCard
	Please charge  to my credit card
Credit Card Number
Expiration
V-Code Number		V-code is the last 3 digits after your card number on the back side of your card just above your signature
Signature

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Complete form, print, and mail along with your check/money order to:

FFCA, PO Box 32571, Oklahoma City, OK 73123-0771

Make Check Payable to: FFCA