BCSC Boutique Order Form Home

	Selection	Quantity	Price	Total
	Sock It to Breast Cancer™ Socks	Trouser Socks Sports Socks (both white)	$10.00
	Sweatshirts (w/ Breast Cancer Survival Center candle logo)	Circle Size: M, L XL	$20.00 $30.00
	Sock It to Breast Cancer™ "Meg" Bear	Brown White Light Brown	$20.00
	Shipping	Under $20.00 $20. and up	$2.50 $4.50
	TOTAL:

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Name:

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Address:

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City, State, Zip Code:

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Phone/E-mail:

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I would like Donate $100, $50, 25________

Please accept my tax-deductible contribution to help provide support and education to breast cancer survivors and their families.

Please make checks payable to Breast Cancer Survival Center and mail to: BCSC, 4 Drummers Trail, Old Saybrook, CT 06475  Thank you.  Donations are tax-deductible to the fullest extent allowed by the law.