Pin, Plaque, and Medal Order Form

Questions about this form? Please contact Bernadette Scruggs.

Director's Name*

First NameLast Name

Email*

School*

Shipping Address*

Street Address

Street Address Line 2

CityState

Zip Code

The Shipping Address listed above is:*

My School's AddressMy Home AddressOther

Please note that it takes 4 to 6 weeks from the time payment is received for your order to be placed and items to arrive. Orders placed after April 20 will likely arrive once schools are finished for the school year. Please consider the following:

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

Would you like to order pins?*

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)

Would you like to order medals?*

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)

Would you like to order plaques?*

YesNo

How many?*

Plaque 1 Type*

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.

Plaque 2 Type*

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.

Plaque 3 Type*

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.

Plaque 4 Type*

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.

Plaque 5 Type*

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.

Plaque 6 Type*

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.

Plaque 7 Type*

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.

Plaque 8 Type*

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.

Pins/Medals x $5.25: $

Plaques x $51.00: $

Characters x $0.15: $

How would you like to pay?*

Credit CardCheck/Money Order

Subtotal

Plus $5.00 Service Fee

Total Amount Due by $ Check/Money Order:

Total Amount Due by: $ Credit Card:

USDPin, Medal, Plaque Order

PM

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Billing Phone Number*

Area CodePhone Number

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.

Pin, Plaque, & Medal Order Form

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