Florida Division Insignia Order Form

							                                                 Florida Division Insignia Order Form
Date ______________________________________

Chapter Name & Number ________________________________________________________________________ District_______

Name: _____________________________________________________________________ Phone (______) _________________

Address: _________________________________________________________________________________________________

___________________________________________________________________________________________________________

City: ________________________________________ State: _________ Nine Digit Zip Code: ________________________________

Email Address: ____________________________________________________________________________________________

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              1) Florida Division Official Pin, $15 + $1.50 postage             ______ x $16.50 =______


                  2) Chapter Top Bar, $10 + $1.50 postage                                          ______ x $11.50 =______


                  3) Division Top Bar, $10 + $1.50 postage                                         ______ x $11.50 =______
                    (Note: To be worn by Florida Division Officers and Past Officers only)

                 4) Chapter Officer Bar, $15 (includes engraving) + $1.50 postage                  ______ x $16.50 = ______

Choose from the following:
Number     Office        Years                  Number       Office            Years
      Vice President                                           Historian
        nd
      2 Vice Pres                                              Recorder
        rd
      3 Vice Pres                                              Chaplain
      Rec. Secretary                                           Corr. Secretary
      Treasurer                                                Parliamentarian
      Registrar

5) Division Officer Bar, $15 (includes engraving) + $1.50 postage                                  ______ x $16.50 = ______
Choose from the following:
Number       Office         Years                  Number      Office             Years
         Vice President                                         Dir. District I
          nd
         2 Vice Pres                                            Dir. District II
          rd
         3 Vice Pres                                            Dir. District III
         Rec. Secretary                                         Dir. District IV
         Treasurer                                              Dir. District V
         Registrar                                              Dir. District VI
         Historian                                              Dir. District VII
         Recorder                                               Corr. Secretary
         Chaplain                                               Parliamentarian

6) Florida Division Page Pin, $25 + $1.50 postage (application needs to be completed)              ______ x $26.50 = ______

Make checks payable to: FL Div Treasurer, UDC                                                Total $______________

Mail form and check to:           Stephanie C. Murphy (Ms.)
                                  1831 Sabal Palm Drive, Apt. 402
                                  Davie, FL 33324-5944
                      Phone: 954-262-2789 E-mail: udcsteph@aol.com
Revised 2011