Form

PSA 2011 NATIONALS T-SHIRT ORDER FORM
Full Name*
Prefix First Name Middle Name Last Name Suffix
Member #

Shipping Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Primary Phone Number
- Area Code Phone Number
Secondary Phone Number
- Area Code Phone Number
E-mail*
Short Sleeve Shirts (Red) $20.00 /each
Quantity Medium (SS)
Quantity Large (SS)
Quantity X-Large (SS)
Quantity XX-Large (SS)
Long Sleeve Shirts (Blue) $25.00 /each
Quantity Medium (LS)
Quantity Large (LS)
Quantity X-Large (LS)
Quantity XX-Large (LS)
One Long Sleeve & One Short Sleeve $40.00 /pair

(Please select Sizes above)
Date:*
- Month - Day Year
Payment Form

Paypal - Select Below Check / Money Order (Made out to PSA)
Total Payment Enclosed (Please add $5.00 Shipping and Handling)
If Paying by Check or Money Order:

Mail to:

PSA
8481 Kenton Rd
Pasadena, MD 21122
PAYPAL: PLEASE REMEMBER TO CLICK SHIPPING AND HANDLING (Please use this only if paying by PayPal. Once you click Submit it will take you to PayPal.) Thanks
Short Sleeve (Red) $20.00 USD

Quantity T-Shirt Size
Long Sleeve (Blue) $25.00 USD

Quantity T-Shirt Size
One of Each (LS, SS) $40.00 USD

Quantity Long Sleeve Quantity Short Sleeve T-Shirt Size Long Sleeve T-Shirt Size Short Sleeve
Shipping and Handling $5.00 USD

Total: $0.00 USD
Should be Empty: