Please use the tab button to navigate - when you hit 'enter' it sends the form SHIPPING INFORMATION BILLING INFORMATION Name  * required Name  * required Address  * required Address  * required City, State, Zip, Country  * required City, State, Zip, Country  * required Day & Evening Phone Numbers  * required Day & Evening Phone Numbers  * required Email  * required Email  * required REGIONAL and AFFILIATE MEDALS RIBBON COLORS Blue # Red # White # Cost per Medal Total # Medals Total $ Amount Regional Medal (1 3/4 ") (w/30" Ribbon) $1.50 Affiliate Medal (2") (w/30" Ribbon) $1.60 OTHER MEDALS   Number Ordered Cost per Medal Total $ Amount DaVinci Medal(2")              BLACK center background (w/30" Black Ribbon) $1.90 Renaissance Award Medal (1 7/8") (w/30" Purple Ribbon)   $1.44 SPIRIT Award Medal (1 7/8") (w/30" Red Ribbon)   $1.44 Rising Stars Medals (1 5/8") (w/30" Red Ribbon) $1.20 OTHER PINS Number Ordered Cost Per Pin Total $ Amount IDODI Pin   $1.16 Dog Tags $1.86 DIAlumni Pins $0.68   Total Order Affilliate Affiliate Name State Competition Date Regional Competition Date(s) 2011-2012 LASTING IMPRESSIONS

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