AMSA Millennium Medal Order Form

Members cost including shipping in the USA .....................$85.00
Non-members cost incl. shipping in the USA ...................$110.00

Outside the USA please include extra postage:
US Postal Service insured ........$10, UPS insured ..........$33.25

Please send me_____copies at $85.00...............................$________
_____ copies at $110.00....................................................$________
Total enclosed..................................................................$________

Ship to: Name____________________________________
Address_________________________________________
City ____________________State_____Zip____________
E-mail address____________________________________

Make your check payable to AMSA (American Medallic Sculpture Assoc.)
Print, fill this form, and Mail your order to:
AMSA, P.O. Box 1201, Edmonds WA 98020
Foreign purchases to be paid in U.S. Dollars drawn to a U.S. Bank