Order Form

Please provide the following ordering information:

QTY	DESCRIPTION

Are you currently a member of the NWPA-ASA?  Yes No

If you are a member, would you like to pick up the items at the next support group meeting?  Yes  No

Please complete all of the following information so that we may contact you to verify shipping and payment information.

	SHIPPING
Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Email
Telephone
We have been experiencing some difficulties with our on-line ordering form.  You may receive an error message after hitting the "Submit Form" button.  Don't complete the form again.  We will confirm your order before we ship it.  If you have not received an email confirming your order within 24 hours, email the webmaster.