(Please print this page and mail with payment)

ALL CLUB JACKETS ARE EMBROIDERED WITH THE CLUB LOGO ON THE BACK AND FIRST NAME EMBROIDERED ON THE FRONT LEFT CHEST AREA.

JACKET SIZES AVAILABLE (PLEASE CIRCLE ONE SIZE ONLY PER ORDER FORM)

ADULT SIZES $68.00 ea. SM MED LRG XL

YOUTH SIZES $65.00 ea. MED (10-12) LRG (14-16) XL (18)

CLEARLY PRINT FIRST NAME TO APPEAR ON LEFT FRONT OF JACKET (one letter per line)

_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

(If you do not want a name on your jacket, please check here ________)

PLEASE FILL IN WHO WE MAY CONTACT WHEN YOUR ORDER IS IN:

NAME _______________________________________________ PHONE (______ ) ________ - ___________

ADDRESS __________________________________________________________ ____________________________________________________________________

Make checks payable to:

South Bay FSC Mail form & fees to: Jean Scully, Skating Edge 23770 South Western Avenue Harbor City CA 90710

METHOD OF PAYMENT: CASH:_______________ CHECK: ______________ DATE PAID:________________ PAYMENT RECEIVED BY: _______________________