Library form

1. Fill out the form below. You may either type on the page and print it out, or you may print the form and fill it in by hand. 
2. Send two checks.
1. One (1) deposit check for $50.00
2. One (1) check for the postage and handling cost ($4 each item picked up in person, or $6.00 each item for us to mail it)
3.  

3. Please mail completed form to, or pick up tapes from:

   WASHINGTON AREA MID EAST DANCE ASSOCIATION
   C/O DANCER
   8010 OLD BRANCH AVE
   CLINTON MD 20735

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Name
Address
City
State
Zipcode
Email Address
Phone

Video selections

First video	Catalog number
Alternates for first video
Second video
Alternates for second video
Third video
Alternates for third video
Fourth video
Alternates for fourth video

Calculate cost

I want to pick up my selections at the library.

No tapes picked up 1 @ $4.00 2 @ $8.00 3 @ $12.00 4 @ $16.00

I want my selections delivered by mail.

No tapes mailed 1 @ $6.00 2 @ $12.00 3 @ $18.00 4 @ $24.00

Due to the cost of postage, we do not ship your order until it can be completely filled.  Please give your choice of 4 items for each one you request. 

The maximum number of items members can have at once is 4.

Items are due back 3 weeks after the mail or pick up time. 

Signature___________________________________   Date ___________

Printed Legal Name _________________________________

Check enclosed           ___________

Money Order enclosed ___________

If you want your items shipped to a PO Box, you must also provide your physical address. _____________________________________________________

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