PW Cancer Awareness Mask Order Form

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Please fill out the form below if you are interested in purchasing a PW Cancer Awareness Mask. All money will be collected upon delivery/pick-up. We will ask that you place cash/check in an envelope. If paying by check, please make it out to "PW Cancer Awareness Club."

Last Name *

First Name *

Select One: *

Student

Staff

Other:

Grade (if a PW Student):

Clear selection

Bonus Block Teacher (if a PW Student)

email: (if a PW student, please use your school email) *

How many masks would you like to pre-order? *

I agree to pay $10 each for the amount of masks I have pre-ordered. (Payment will be expected at the time of pick-up) *

Yes

Required

Submit

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