Breast Cancer Fundraiser T-shirt Form

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Please fill out the information below and use the PayPal link on our website to complete your order. Orders will be accepted through 10/01/19. You will receive an email confirmation of your order from the WCC. If you do not receive a confirmation email, or have any questions, please contact Dr. Michelle Ward (michelle.ward@pitt.edu).

First Name *

Last Name *

Email Address: *

Phone Number:

Please choose from the following to let us know what you ordered: *

small t-shirt(s)

medium t-shirt(s)

large t-shirt(s)

XL t-shirt(s)

2XL t-shirt(s)

free tote with each purchase of two shirts

Required

Choose from the following: *

I will make arrangements to pick up my order once it is in

I would like to pay for shipping my order to my home/business

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