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California Rainbow |
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Membership Pins Order Form - *** Please print as
LANDSCAPE until I can fix it. |
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New Initiate
Name
Date Initiated |
Name of Girl
or Adult bringing in new member and receiving award* |
CA Top Bar
$3.00 |
R
$1.50 |
A
$1.50 |
I
1.50 |
N
$1.50 |
B
$1.50 |
O
$1.50 |
W
$1.50 |
POG
n/c |
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Make checks payable to : GRAND ASSEMBLY
(Remember, two signatures required on assembly checks!) |
*Please Note
Only one girl OR one adult may receive award per initiate |
| Amount of Order |
$_______.____ |
Assembly |
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| Shipping |
$______2.50__ |
Mother Advisor |
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| Total Enclosed |
$_______.____ |
MA Address
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MA Phone # |
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MA Email |
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Print this form using your browser's print button.
Use LANDSCAPE mode.
Fill it out and mail to Mrs. Ellen Griffin, PMA at 13046 Spring Lake Street,
Redding, CA 96003
Phone: 530-275-3636 (evenings) Email: EllenG1284@aol.com
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03/23/2008 |
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© Copyright, 1999,
2000, 2001, 2002, 2003, 2004, 2005, 2006
by California Grand Assembly of the International Order of the Rainbow for Girls. |
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