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 STATE MEDALS RIBBON COLORS Black # Red # White # Total # Medals Total $ Amount Regional Medal (1 3/4 ") $ State Medal (2") $ OTHER MEDALS   Number Ordered Cost per Medal Total $ Amount DaVinci Medal(2")              BLACK center background (w/30" Black Ribbon) $ Renaissance Award Medal (1 7/8")   $ SPIRIT Award Medal (1 7/8")   $ Rising Stars Medals (1 5/8") $ CHALLENGE PINS Size 1 1/2" Number Ordered Cost Per Pin Total $ Amount Private DI $ A New Angle $ Instant Challenge $ Hidden! $ Operation Cooperation $ Take Charge $ Instinct Messaging $ Team Manager LI 3531 (1 1/4") $ OTHER PINS Number Ordered Cost Per Pin Total $ Amount DI Earrings $/pair Dog Tags $ Appraiser Pin $ Parent Pin $ IDODI Pin   $   Total Order Affilliate Affiliate Name State Competition Date Regional Competition Date(s) October 2007 LASTING IMPRESSIONS

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