Race Week Celebrity Auction Sale Item Order Form

Please use this form to order items that we are offering for sale.

     NAME:                                                                                                

     ADDRESS:                                                                                                 

     CITY, STATE & ZIP:                                                                                               

     PHONE:                                                                                              

     ITEM DESCRIPTION:                                                                                               

     NUMBER OF ITEMS:                                                                                               

     PRICES:   Posters -- $2.00 each      Shipping = $2.50 (for 6 posters).                 
                        Magazines -- $1.50 each       Shipping = $1.50 each.                      

     TOTAL AMOUNT:                                                                                             (remember shipping)

     VISA/MC/AMEX #:                                                                                   EXP. DATE:                    

After filling out this form, mail or fax it to us at:

• Conklin Centers for the Blind
• 405 White Street
• Daytona Beach, FL 32114
• Fax: (904) 258-1155

You may Email the above information to at the Conklin Center.

For more information call Pat Mihalic at (904) 258-3441.

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