EMS symbol of Shadrach, Meschach, Abednego
Illinois Great Rivers Conference 
United Methodist Men
"Bridging the Gap"
Bridge Photo
ORDER FORM FOR CONFERENCE VEST
ILLINOIS GREAT RIVERS CONFERENCE
Medium      @ $16.  ___ Qty   Amount of Order $_______.____
Extra Large @ $16.  ___ Qty   Amount of Order $_______.____
Extra (2X)  @ $18.  ___ Qty   Amount of Order $_______.____
Extra (3X)  @ $19.  ___ Qty   Amount of Order $_______.____

Frills: (Enter name at bottom)(If no frills needed, leave blank)

Press on Full Name @ $3 (Same lettering as emblem) $_______.____
Embroidered Name (sewed) 1st name only @$5  $_______.____
Embroidered First and last Name @ $8. $_______.____
Other embroidery @ $5. per word $_______.____
  Total amount enclosed $_______.____ (Checks only please) 

Send To:(Your mailing address)

 Last:_____________________________ First:_____________________MI__________

 Address:_______________________________________

 City:____________________________ State:______ ZIP:___________

 Phone: (____)_______ _________

 Church Affiliation:___________________

 Check payable to Illinois Great Rivers Conference-United Methodist Men(IGRCUMM)

Mail to one of the following

Jerry Motsinger
1004 N McMullen Rd
Bartonville, IL 61607 		 Jim Bolinger
  P O Box  461
Findlay, IL  62534
 Ted Kornegay
53 Ingham Lane
Godfrey, IL 62035

Clearly PRINT name or words to add on as frill here:
                                                                                                       Location(Front or Back)
_________________________________________________     Top/Bottom/Left/Right

_________________________________________________

_________________________________________________

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