Florida State Society Daughters of the American Revolution Kay Yarbrough, State Regent Ramona “Flash” Glenn, State Vice Chair 3801 Oakview Dr, Sebring, Fl. 33876-9556 863-655-9610 [email protected] KAY YARBROUGH State Regent D A R FSSDAR NAME BADGE ORDER FORM Ordering method for name badges and ribbon magnets: Chapter Name:____________________________________________ Member Contact: __________________________________________ Mailing Address:_____________________________________Fl_____ Phone: ___-____-_____ email:________________________________ This order is for : #_____Badges @ $17 each; #____Magnets @ $5 each $______ Chapter Check # ______$_____ (Payable to FSSDAR, Treasurer) Mail this form and your chapter check to Ramona “Flash” Glenn, State Vice Chair, 3801 Oakview Dr., Sebring, Fl. 33876-9556 FOR STATE VICE CHAIRMAN USE: DATE RECIEVED: DATE MAILED TO CHAPTER: 1) A chapter check is required, payable to FSSDAR Treasurer 2) FSSDAR name badges are $17.00 each 3) Magnetic back is standard. A pin back is available by request 4) Extra magnets for your insignia ribbon are available for purchase for $5.00 5) Orders will be mailed ONCE a month to ONE Chapter member for distribution 6) Badges may be purchased for HODARs 7) List below the name you wish to be called (i.e. Ann Smith, not Ann Yolanda Jones Smith) (If member goes by a double first name like “Mary Ann” please note) 8) You may include your DAR title (office or chairmanship) and chapter name Name for badge DAR Title Orange Logo (Y OR N) ______________________________ Pin Back (Y OR N) ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ List additional name on the reverse side. PLEASE DO NOT send duplicate orders. SRP 12 2019