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Centennial History Order Form NAME ____________________________________________________________ STREET ADDRESS _________________________________________________ CITY/STATE _______________________________ ZIP CODE ______________ PHONE ____________________ E-MAIL ________________________________ I wish to pre-order ______ copies of the Delta Omicron Centennial History at the reduced 2006 Conference cost of $40.00 each. I choose to pay by the following method: (check one) __________ Check (Payable to Delta Omicron International Music Fraternity) __________ Money Order (Payable to Delta Omicron International Music Fraternity) __________ Credit Card (Complete the information below) If paying by credit card, give the following information. VISA, MasterCard, or Discover in US FUNDS ONLY; a 4% surcharge applies to all credit card orders. Check one of the following options: _____ VISA _____ MasterCard _____ Discover Name as imprinted on the Card _______________________________________ Card Number ______________________________________________________ Expiration Date ____________________________________________________ Signature _________________________________________________________ Mail this form and your payment to Jennifer Klafeta, National Treasurer, 665 Pembridge Lane, Unit C, Prospect Heights, IL 60070. Orders must be postmarked by July 31, 2006 to be eligible for the reduced $40 pricing. |