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DCA 2011 Order Form

All mailed orders must be postmarked by March 15, 2011. Make checks payable to: The Dalmatian Club of America. Checks must be issued in US currency. VISA, Mastercard, AM EX, Discover (and PayPal through the DCA website) are accepted. Mail your order form with payment to: Toni Linstedt, 1048 Woodfield Estates Drive, Town and Country, MO 63017. email: jujudal@sbcglobal.net phone - 314-453-4952 or 314-495-9024. Or take advantage of easy ordering online and see photos of Logo Items at http://www.dcanational.com/2011/orderforms.html All Logo Items and Performance Fund Items will be shipped via USPS two weeks prior to the Specialty.

Name

_________________________________________ Street Address ___________________________________ ____________________________________________ City____________________________ State__________

Cell Phone # (Req for RV) ____________________________ Email ________________________________________ Payment - Check___ MC___ VISA___ Discover____ AMEX___ Credit Card #____________________________________

Zip/Postal Phone #

______________

_______________________________________

Exp Date Signature

____________

Security Code

_________________

______________________________________

ITEM

SIZE

COLOR

QTY

PRICE EACH

TOTAL PRICE

Logo Short Sleeve Polo Shirt - Men’s & Women’s Sizes - S, M, L, XL, 2X, 3X -

$34.00

Colors - Green or Coffee Logo Zippered Hoodie - Unisex Sizes - S, M, L, XL, 2X, 3X - Navy or Red Logo Softside Briefcase -Gray, Green, Navy or Maroon Logo Black & White Dog Shaped Pick Up Bag Dispenser Show Catalog - $25 Pick Up at Show; $30 Mailed after Show DCA Awards Banquet Buffet Top Twenty Seating Top Twenty Catalog ` $10 Pick Up at Show; $15 Mailed after show Performance Fund:

$40.00 $30.00 $6.00

$35.00 $10.00

T Shirt : Unisex Sizes - S, M, L, XL, 2X $35.00 (3X for $5 more) Performance Fund Limited Edition Print Performance Fund T Shirt & Limited Edition Print : Unisex Sizes - S, M, L, XL, 2X $75.00 (3X for $5 more)

$55.00

Performance Fund - Other Amount Quilt Raffle Tickets - 6 for $5; 12 for $10; 25 for $20 Welcome Party Jr. Handler Outing RV Parking - Indicate # of nights in Quantity

No Charge No Charge

Arrive Date RV Length Depart Date __ _______________ RV Type _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Tow Vehicle: Y / N _________ RV Sanitation Service RV Water Service Class Trophy Placement (Use insert Trophy section to complete details) - $55 for 1st Place; $45 for 2nd Place; $30 for 3rd Place; $25 for 4th Place Breeder’s Directory Listing: Kennel Name___________________________ __________________

$25.00/nite

$35.00 $20.00

$5.00

Website:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Catalog Advertising (See details on Catalog Advertising insert section)

Grand Totals

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