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
Name ____________________________________________________________
Address ______________________________________________________________________________
City/State _______________________________________ Zip ________________________
