SRFC Fundraiser Order Form (Fall 2023)
Please fill out this form in order to reserve your jacket and/or badge reel. If you would like more than one, simply fill out the form again! Jackets are $45 and will feature the SRFC logo and your name. Badge reels are $5. 

The form closes on August 1st at 11:59 pm.

Payment information is included at the end of the form and must be received prior to the deadline in order to receive your items. You will receive a confirmation email regarding your payment.

SRFC Liaisons will be contacting you with information regarding pickup.

If you have any questions, please don't hesitate to contact us at srfc@southalabama.edu
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Email *
Name (First and Last) *
Phone Number *
Health Professional School or Association *
Badge Reel Preview
Jacket Preview - We are excited to offer both a men's and women's fit. These jackets are lightweight, water-resistant, and great for wearing in the hospital! These jackets will have our SRFC logo on the left side and your name on the right side. 
Which jacket fit would you prefer?
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Jacket size
Clear selection
How would you prefer your name to appear on the jacket pocket? (Ex - Dr. Mark L. Smith)
Would you like a badge reel?
Clear selection
Payment should be sent to the SRFC President (Chandler Hinson). 

Please select "Friends and Family" when processing to prevent service fees from being applied. All proceeds will go towards clinic operations and patient care. 

Each jacket is $45. Each badge reel is $5.
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A copy of your responses will be emailed to the address you provided.
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