USNA Gift Shop Order Form
( by Mail Only)

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Please make checks payable to: UTAH SCHOOL NURSES ASSOCIATION

Mail to:

Please check the item, then circle desired size

Item________________________________ Size_____________ Color_____________ Price____________

Item________________________________ Size _____________ Color_____________ Price____________

Item________________________________ Size_____________ Color _____________ Price____________

Item________________________________ Size_____________ Color______________ Price____________

Postage and Handling ($6.00 for up to 2 items)

Total Amount Enclosed: Check Number ________ $ ___________

Please mail order form and check (including postage and handling) with the following information:

Name ____________________________________

Address___________________________________
City ______________________________________
State _______________________Zip ___________

Home Telephone (including area code)____________________

Work Telephone (including area code)____________________
Please allow 3 weeks for delivery, thank you for your order.

Any questions please email

Thank you for your support of the Utah School Nurses Association!
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