Pin, Plaque, and Medal Order Form

Pin, Plaque, & Medal Order Form

Georgia Music Educators Association
Questions about this form? Please contact Bernadette Scruggs.
SHIPPING INFORMATION
Director's Name*

First NameLast Name
Email*
School*
Shipping Address*

Street Address

Street Address Line 2

CityState

Zip Code
My School's AddressMy Home AddressOther
Please go ahead and place my order now and have it delivered to the shipping address listed above. This address accepts summer deliveries.Please wait until July 10th to place my order and deliver to the shipping address listed above.Other
PRODUCTS
YesNo
Number of Choral Large Group Superior Pins (C37S8)
(Minimum order of 10)
Number of Choral Large Group Excellent Pins (C37C8)
(Minimum order of 10)
Number of Solo & Ensemble Superior Pins (C36S8)
(Minimum order of 10)
Number of Solo & Ensemble Excellent Pins (C36C8)
(Minimum order of 10)
YesNo
Number of District Clinic Medals (C582C2 White)
(Minimum order of 10)
Number of Instrumental Large Group Superior Medals (C90S5 Blue)
(Minimum order of 10)
Number of Instrumental Large Group Excellent Medals (C90C6 Red)
(Minimum order of 10)
Number of Choral Large Group Superior Medals (C88S5 Blue)
(Minimum order of 10)
Number of Choral Large Group Excellent Medals (C88C6 Red)
(Minimum order of 10)
Number of Solo & Ensemble Superior Medals (C89S5 Blue)
(Minimum order of 10)
Number of Solo & Ensemble Excellent Medals (C89C6 Red)
(Minimum order of 10)
YesNo
How many?*
SuperiorExcellent
Plaque 1, Line 1

0/32
Plaque 1, Line 2

0/32
Plaque 1, Line 3

0/32
Plaque 1, Line 4

0/32
Plaque 1, Line 5

0/32
Plaque 1, Line 6

0/32
Plaque 1, Line 7

0/32
Total Number of Characters for Plaque 1*
Each line shows the number of characters used. Please add them and type the total here.
SuperiorExcellent
Plaque 2, Line 1

0/32
Plaque 2, Line 2

0/32
Plaque 2, Line 3

0/32
Plaque 2, Line 4

0/32
Plaque 2, Line 5

0/32
Plaque 2, Line 6

0/32
Plaque 2, Line 7

0/32
Total Number of Characters for Plaque 2*
Each line shows the number of characters used. Please add them and type the total here.
SuperiorExcellent
Plaque 3, Line 1

0/32
Plaque 3, Line 2

0/32
Plaque 3, Line 3

0/32
Plaque 3, Line 4

0/32
Plaque 3, Line 5

0/32
Plaque 3, Line 6

0/32
Plaque 3, Line 7

0/32
Total Number of Characters for Plaque 3*
Each line shows the number of characters used. Please add them and type the total here.
SuperiorExcellent
Plaque 4, Line 1

0/32
Plaque 4, Line 2

0/32
Plaque 4, Line 3

0/32
Plaque 4, Line 4

0/32
Plaque 4, Line 5

0/32
Plaque 4, Line 6

0/32
Plaque 4, Line 7

0/32
Total Number of Characters for Plaque 4*
Each line shows the number of characters used. Please add them and type the total here.
SuperiorExcellent
Plaque 5, Line 1

0/32
Plaque 5, Line 2

0/32
Plaque 5, Line 3

0/32
Plaque 5, Line 4

0/32
Plaque 5, Line 5

0/32
Plaque 5, Line 6

0/32
Plaque 5, Line 7

0/32
Total Number of Characters for Plaque 5*
Each line shows the number of characters used. Please add them and type the total here.
SuperiorExcellent
Plaque 6, Line 1

0/32
Plaque 6, Line 2

0/32
Plaque 6, Line 3

0/32
Plaque 6, Line 4

0/32
Plaque 6, Line 5

0/32
Plaque 6, Line 6

0/32
Plaque 6, Line 7

0/32
Total Number of Characters for Plaque 6*
Each line shows the number of characters used. Please add them and type the total here.
SuperiorExcellent
Plaque 7, Line 1

0/32
Plaque 7, Line 2

0/32
Plaque 7, Line 3

0/32
Plaque 7, Line 4

0/32
Plaque 7, Line 5

0/32
Plaque 7, Line 6

0/32
Plaque 7, Line 7

0/32
Total Number of Characters for Plaque 7*
Each line shows the number of characters used. Please add them and type the total here.
SuperiorExcellent
Plaque 8, Line 1

0/32
Plaque 8, Line 2

0/32
Plaque 8, Line 3

0/32
Plaque 8, Line 4

0/32
Plaque 8, Line 5

0/32
Plaque 8, Line 6

0/32
Plaque 8, Line 7

0/32
Total Number of Characters for Plaque 8*
Each line shows the number of characters used. Please add them and type the total here.
PAYMENT
Pins x $4.75: $
Medals x $5.75: $
Plaques x $59.00: $
Characters x $0.15: $
Credit CardCheck/Money Order
Subtotal
Plus $8.00 Service Fee
Total Amount Due by $ Check/Money Order:
Billing Phone Number*

Area CodePhone Number

Total Amount Due by: $ Credit Card:

USDDescription

Credit Card Info

REVIEW
Please review your order and click the "Submit" button below. You will be taken to a confirmation page and will also receive an email confirmation that will include a copy of your order.
Please review your order and click the "Submit" button below. You will be taken to a confirmation page and will also receive an email confirmation that will include a copy of your order. Please print the invoice and mail it with a check to the address listed on the invoice.

*Your order will be considered incomplete until payment has been received.

*Once payment has been received, please allow 4-6 weeks for your order to arrive. There are no provisions for rush orders.

*We accept GMEA member personal check, school checks, booster checks, and money orders. GMEA does not accept non-member checks or purchase orders.
Should be Empty:

Pin, Plaque, & Medal Order Form

SHIPPING INFORMATION

PRODUCTS

PAYMENT

Credit Card Info

REVIEW