First Name:______________________________________________
Last Name:_______________________________________________
Local Street Address:______________________________________________________
Apt./Box No.:__________
City:______________________________ State:_________ ZIP:___________________
Country:_______________ (please contact us for shipping outside U.S.)
Email:_________________________________________________________________
Phone:_________________________________________________________________
How many T-shirts would you like?
Small Blue Men's: ________
Med. Blue Men's: ________
Large Blue Men's: ________
X-Large Blue Men's: ________
Small Blue Women's: ______
Med. Blue Women's: ______
Large Blue Women's: ______
Small Green Men's: ________
Med. Green Men's: ________
Large Green Men's: ________
X-Large Green Men's: ________
Small Green Women's: ______
Med. Green Women's: ______
Large Green Women's: ______
Total # shirts ordered= ______
Total = ( (Total # shirts ordered, _____) x $10.00 ) + ($3.00 shipping) = $_________
(for example, $13 for 1 shirt, $23 for 2 shirts, etc.)
Amount enclosed: $_____________________
Date:________________________________
Mail (with payment, a personal check or money order made out to "UCIMC/The Bike Project") to:
The Bike Project
202 S. Broadway Ave, #24
Urbana, IL 61801