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					                  LPCW T-SHIRT & SWEATSHIRT ORDER FORM




                    T-Shirts: $12.00                               Sweatshirts: $18.00
LPCW t-shirts and sweatshirts are printed with the black logo on the front and our trademarked
"WARNING: the Surgeon General has determined that music, dance, and theatre will cause happiness in
most individuals." on the back.

Please fill out the form completely and return it with credit card information or a check to the fax or
address below. Your order will be mailed directly to you!

FAX ORDER TO: 252-321-8540                  MAIL ORDER TO: LPCW T-Shirt
                                                          740 SE Greenville Blvd., PMB 270
                                                          Greenville, NC 27858
CIRCLE CHOICES:

                             Type:          T-Shirt        or       Sweatshirt

                    Youth Size:            S(6-8)          M(10-12)             L(14-16)

             Color:   Lime Green    Blue   Hot Pink   White
    ________________________________________________________________

                             Type:          T-Shirt        or       Sweatshirt

                     ADULT Size:                S            M            L           XL

                   Color:         Lime Green           Blue        Hot Pink         White

                                                                     ORDER TOTAL:_____________
                                                                        Shipping/Handling: + $5.00

                                                                   TOTAL INCLUDED:___________
Name:___________________________________

Address:_________________________________

City:_______________________State:________Zip:__________

Please charge my: MC/VISA

Card Number:________-______-______-______Exp:__________

Authorized Signature:

                   Date:

				
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