PLEASE PRINT CLEARLY

NAME: FIRST___________________________LAST___________________________________

STREET_______________________________________________________________________

CITY_____________________________________________STATE__________ZIP+4_______-____

PHONE WITH AREA CODE:_____________________________________________________

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BASEBALL CAPS WITH LOGO - QUANTITY ORDERED _________@ $12.00 EACH

SHIRT ORDERS:

TEE SHIRTS: The wives may order also if they wish.

COLOR: NAVY BLUE ______

SMALL TO EXTRA LARGE---------------------------------------------------------------$15.00
TWO FOR.............................................................................................................$25.00

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PLEIKU AIR BASE ASSOCIATION PATCH  .............................................$3.00  OR 2 FOR $5.00

PLEIKU AIR BASE ASSOCIATION DECAL...............................................$2.00

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Postage included in price.

TOTAL AMOUNT ENCLOSED----------------------------------------------------------$___________

MAIL TO:

TOM RUSHNOCK
1628 Taylor Avenue
ARNOLD, PA 15068 -4135

MAKE CHECKS PAYABLE TO : Pleiku Air Base Association 
Please indicate size and quantity for each item! 

THANK YOU. PLEASE ALLOW 3-4 WEEKS FOR DELIVERY