ITEM PRICE QUANTITY $SUBTOTAL
1 Adult Active member $ 64.50 _________ $__________
1 Family Unit - all active $100.50 _________ $__________
1 Adult Active + other
non-active family members $89.05 _________ $__________
Name tags
Magnetic $ 11.00 _________ $__________
Pin $ 10.00 _________ $__________
Total: $__________
Names as you would like to have appear on name tags
_____________________________________________________ Pin Magnetic