Official New York State and Bermuda Tie and Patch 
ORDER FORM
  




New York State and Bermuda official tie                 _____  at  $20.00 each =  ______

New York State and Bermuda official patch          _____  at  $6.00 each =  ______



                                       TOTAL ENCLOSED      __________



Please send payment ( CHECK OR MONEY ORDER, no credit cards) to:


MD-20 New York & Bermuda Lions Inc.
1215 James Street   
Syracuse, NY  13203



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Address ______________________________________________________________________________

City/State _______________________________________   Zip  ________________________