Baylor University Louise Herrington School of Nursing BSN

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Semester Attending                                                                                                          Quantity Ordered
                                        Baylor University
Spring ... _____                                                                                                         Initial Order ..     ______
                               Louise Herrington School of Nursing                                                       Add. Sets ......     ______
FastBacc _____                                                                                                           Add. Single ...      ______
                                                                                                                         Amount Paid .        ______
                                                                                                                         Cash .............   ______
Fall ......... _____                    BSN UNDERGRADUATE                                                                Check # ........     ______
                                         Name Badge Order Form

        Two badges are required by school policy. Badge 1 will have your first name only and
        Badge 2 will have both first & last name. The total price for both badges is $15.65
        You may be by Cash, Check or Money Order*. Make Payable to: Baylor University.

        Please complete the information below:                                                                  Betty Baylor
                                                                                                          Undergraduate Student
                                                                                                                 BAYLOR UNIVERSITY
        Badge 1: Your First Name______________________                                                        LOUISE HERRINGTON SCHOOL
                                              First Name                                                              OF NURSING

        Badge 2: Your First and Last Name_______________________                            ____________________________
                                                       First Name                                 Last Name

        You may order additional sets or individual badges at the listed prices below. The price for an
        additional set is $15.65. The price for an additional single is $10.00

        For additional badges, please check the appropriate box(s)

        I would like to order an additional      Set(s)_____________________________________________
                                                           Please indicate set: 1 each Badge 1 & 2 OR 2 of Badge #1 OR 2 of Badge #2
        I would like to order an additional      Single ____________________________________________
                                                           Please indicate 1 of Badge 1 OR 1 of Badge 2

        Make Check or Money Order Payable to:                      Baylor University

                          Mail Your Order To:                      Baylor School of Nursing
                                                                   ATTN: Jennett Brovont
                                                                   3700 Worth Street
                                                                   Dallas, TX 75246
        *No credit cards

        *NOTE: Your name badges will be given to you during orientation at the nursing school.
        Mail this in as quickly as possible. If you have further questions or need help, please don’t
        hesitate to contact our office at 214-820-4160.

                                                       Updated 10/8/2010

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