| DISTRICT 2009 |
| GWRRA PATCH ORDER FORM |
| |
|
|
|
|
|
|
|
|
| Mail Order to: |
|
|
|
Send Form to: |
|
| |
|
|
|
District Patch Shop |
|
|
| Name |
|
|
|
Mary
Lou Stamm |
|
| Address |
|
|
|
2471
East 13th Avenue |
|
|
| City/State/Zip |
|
|
|
Columbus, NE 68601-3719 |
|
|
| Phone |
|
|
|
rstamm@neb.rr.com |
|
|
| Email |
|
|
|
FULL PAYMENT |
| Chapter |
|
|
MUST ACCOMPANY
ORDERS |
| Date |
|
|
|
MAKE CHECK PAYABLE TO
GWRRA |
| |
|
|
|
|
|
|
|
|
| |
COST |
QTY |
|
|
|
|
|
TOTAL |
| DESCRIPTION |
EACH |
|
SPECIFY |
|
|
|
|
COST |
| 10" RED GRIFFIN PATCH |
$10.00 |
|
|
|
|
|
|
|
| 10"BLACK GRIFFIN PATCH |
$12.00 |
|
|
|
|
|
|
|
| 4" RED GRIFFIN PATCH |
$4.50 |
|
|
|
|
|
|
|
| 4" BLACK GRIFFIN PATCH |
$5.00 |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| 4" LIFE MEMBER PATCH |
$5.00 |
|
|
|
|
|
|
|
| REGION E BLACK PATCH |
$6.00 |
|
|
|
|
|
|
|
| M.A.D. PATCH |
$6.00 |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| 4" ORIGINAL WHITE MEMBER PATCH |
$2.00 |
|
|
|
|
|
|
|
| 6" GWRRA ROCKER, WHITE/RED |
$2.50 |
|
|
|
|
|
|
|
| COUNTY MAP
SPECIFY STATE |
$6.50 |
|
IA,
IL, MN, MO,
WI |
|
|
|
|
| USA MAP |
$6.50 |
|
|
|
|
|
|
|
| MEMBERSHIP PIN RED GRIFFIN |
$3.00 |
|
|
|
|
|
|
|
| MEMBERSHIP PIN BLACK GRIFFIN |
$3.50 |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| 4" DECAL, RED GRIFFIN |
$1.00 |
|
|
|
|
|
|
|
| INDIVIDUAL OF THE YEAR 4" PATCH |
$5.00 |
|
|
|
|
|
|
|
| COUPLE OF THE YEAR PIN |
$5.00 |
|
|
|
|
|
|
|
| COY YEAR BAR
SPECIFY YEAR |
$2.00 |
|
|
|
|
|
|
|
| COY BAR-CHAPTER/DISTRICT/REGION |
$2.00 |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| MILITARY PATCH ACTIVE & SEAL |
$6.00 |
|
BRANCH: |
|
|
|
|
|
| MILITARY PATCH RETIRED & SEAL |
$6.00 |
|
BRANCH: |
|
|
|
|
|
| MILITARY PATCH RESERVE & SEAL |
$6.00 |
|
BRANCH: |
|
|
|
|
|
| MILITARY PATCH VETERAN & SEAL |
$6.00 |
|
BRANCH: |
|
|
|
|
|
| MILITARY BRANCH SEAL ONLY |
$2.00 |
|
|
|
|
|
|
|
| 6" GWRRA ROCKER, RED/WHITE |
$2.50 |
|
|
|
|
|
|
|
| LAPEL PINS-LEFT/RIGHT (HELMET) |
$3.00 |
|
|
|
|
|
|
|
| EARRINGS, RED, DANGLE, (HELMET) |
$2.50 |
|
|
|
|
|
|
$ -
|
| |
|
|
|
|
TOTAL PAGE 1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| PATCH COLOR
CODES |
WHITE=W RED=R BLACK=B |
|
|
|
|
| TRIM COLOR
CODES |
RED=R BLACK=B YELLOW=Y GOLD=G |
|
|
|
| LETTER COLOR
CODES |
WHITE=W RED=R
BLACK=B YELLOW=Y GOLD=G
BLUE=BU |
|
| ROCKERS |
COST
EACH |
QTY |
|
|
|
Total Cost |
|
| BACK ROCKER (OVER 10"
PATCH) |
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| 2 lines |
$8.50 |
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| BACK ROCKER (UNDER 10"
PATCH) |
|
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| 2 lines |
$8.50 |
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| CITY BAR |
|
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| |
$7.50 |
|
|
|
|
|
|
| 2 lines |
$8.50 |
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| FRONT ROCKER OVER |
|
|
|
|
|
|
|
| |
$5.00 |
|
|
|
|
|
|
| |
$5.00 |
|
|
|
|
|
|
| |
$5.00 |
|
|
|
|
|
|
| 2 lines |
$6.00 |
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| FRONT ROCKER
UNDER |
|
|
|
|
|
|
|
| |
$5.00 |
|
|
|
|
|
|
| |
$5.00 |
|
|
|
|
|
|
| 2 lines |
$6.00 |
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| POSTAGE CHARGES |
Page 2 TOTAL |
|
|
| $0.00 - $8.00 $1.00 |
$150.01 - $175.00 $7.00 |
|
|
|
|
|
| $8.01 - $14.00 $1.50 |
$175.01 - $200.00 $8.00 |
|
|
|
|
| $14.01 - $20.00 $2.00 |
$200.01 - $300.00 $9.00 |
|
|
|
|
| $20.01 - $40.00 $2.50 |
$300.01 - $400.00 $10.00 |
|
Total Page 1 |
|
|
| $40.01 - $60.00 $3.50 |
$400.01 - $500.00 $11.00 |
|
Total Page 2 |
|
|
| $60.01 - $75.00 $4.50 |
$500.01 - $600.00 $12.00 |
|
Sub Total |
|
|
| $75.01 - $95.00 $5.50 |
$600.00 - $700.00 $13.00 |
|
Postage / Insurance |
|
|
| $95.01 - $150.00 $6.00 |
|
|
|
|
|
| |
|
|
Total Amount |
|
|
| |
|
|
|
|
|
|
|
|