LAMA JACKSONVILLE ORDER FORM

Paid: ____________

Not Paid: _________

Date: ______________ Balance: __________

Member: ________________________________

New member: Yes / No

Chapter member: ______

Spousal member: ______

Associate member: ______

Brother Club member: ______

International Membership patch w/service rocker ($20/$40): ______

Prospect patch ($20): ______

Probate - Top & Bottom Rockers ($25): ______

Wings (Center patch-$25): ______

DAMA De LAMA patch ($10) ______

USA patch ($5): ______

City patch (N/C): ______

Current Rally patch ($6): ______

Past Rally patch ($3): ______

LAMA USA Flag ($5): ______

Florida State Patch ($3): ______

Country/State Flag ($6): ______

Alterations (Initial $15/Associates $10/Add on $5): ______

Name patch ($10) ______

Official L/S T-shirt (S-XXL $18.50 & 3XL $19.50) ______

Official S/S T-shirt (S-XXL $15 & 3XL $16) ______

Full color Muscle Shirt (S-XXL $13) ______

Gold/White Muscle Shirt (S-XXL $12 & 3XL $13) ______

Full color Tanks (S-XXL $13) ______

Gold/White Tanks (S-XXL $10) ______

LAMA Divas Tanks (S-XXL $15) ______

LAMA Youth T-shirt (S-L $10) ______

Chapter Bandana ($6) ______

Chapter Sticker ($5) ______

LAMA Jacksonville Pin ($5) ______

Grand Total: ___________

Member submitting: ________________________________

(* Bold = Minimum requirement for new members) Rev. 10/2009