| *Email: | |
| *Phone number: (and best time to call) | |
| *Organization name: (Church, School, Court, etc) | |
| *Mailing address: | City: State: Choose a state: or Province: (Leave blank in US) Country: Other Country not listed above or leave blank: *Zip or Mail Code: | 
| When do you plan to wear/use the items? (Choose one) | not sure immediately within a month within a year in time for my event on: | 
| Age group: (choose any that pertain) | |
| Approximate number of people: | |
| Interested in: (choose any that pertain) | Other: |