HAR-089 Replacement Pin/Medal Order Form

The replacement of any defective pin shall be left to the discretion of the Corporate Assistant. Please email corporateoffice@harmonyinc,org if you require replacement of a defective pin or medal.

Your name*

First NameLast Name

Chapter (if applicable)

Email*

example@example.com

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Country*

CanadaUSA

Instructions: Check the box for each item required, then enter the quantity of each item in the space provided. Additional information is required for orders of replacement medals, name tags, and Years of Membership pins.

Please see Section 1 Pages 1.16-1.17 of the Corporate Manual for a description of each pin and its authorized use.

What item(s) do you require? Select all that apply.

Years of Membership Pins $10*

Total number of Years of Membership Pins

Replacement Chorus Medals $12 *

Total number of replacement chorus medals

Replacement Quartet Medals $14*

Total number of replacement quartet medals

Membership Pin $10

enter quantity

Barbershopper of the Year Pin $10

enter quantity

Service Pin $10

enter quantity

Chapter President Pin $20

enter quantity

International President Pin $20

enter quantity

Certified Judge Name Tag $13

enter quantity

IBOD/Assistant or Advisor Name Tag $18

enter quantity

SiNG Magnet $5

enter quantity

Name as desired on Name Tag

First and Last name

Title for Name Tag

e.g. Area Director

Subtotal

Shipping & Handling

Total Due

Choose a payment method:

PayPalCheck or Money OrderE-transfer to financeoffice@harmonyinc.org (Canadian banks)Zelle to financeoffice@harmonyinc.org (US banks)

In which currency do you want to pay?*

CAD (pay by e-transfer or Canadian funds cheque)USD (pay by PayPal or US funds check)

Currency Exchange

Example:

The rate on 17 October 2022 was 1 USD = 1.3730 CAD,
so you would enter 1.3730 into Exchange Rate

The Bank of Canada closing exchange rate is shown below. You may also get the rate by visiting https://www.bankofcanada.ca/rates/exchange/currency-converter/

Copy all digits of the CAD figure into the field labeled "Exchange rate." The form will use that figure to calculate the total due in your selected currency.

Current Bank of Canada Exchange Rate:

Exchange Rate*

This amount CAD = $1 USD

calculation

Total due CAD

Dollar amount*

USDDescription

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HAR-089 Replacement Pin/Medals Order