ATHS Central California Chapter Badge and Swinger order Form Please print this form and send with your check to ATHS Central California Chapter 4132 Alan Drive North Highlands Ca. 95660 ORDER Date  ___/___/______                                     Check #___________          Amount Sent $__________ ____________________________________________________________________ Name  __________________________     Town & State   __________________________    Chapter Name  __________________________    $ 10.00 Swinger        ___________________________        $2.00 each Swinger        ___________________________        $2.00 each Swinger        ___________________________        $2.00 each ____________________________________________________________________                Name  __________________________     Town & State   __________________________    Chapter Name  __________________________    $ 10.00 Swinger        ___________________________        $2.00 each Swinger        ___________________________        $2.00 each Swinger        ___________________________        $2.00 each ____________________________________________________________________       Name  __________________________     Town & State   __________________________    Chapter Name  __________________________    $ 10.00 Swinger        ___________________________        $2.00 each Swinger        ___________________________        $2.00 each Swinger        ___________________________        $2.00 each ____________________________________________________________________ Mail Badge To                              Name         _________________________________________                              Address     _________________________________________                              City State and Zip _____________________________________                              Contact Phone #  _____-______-_____________ ____________________________________________________________________