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Order Form

Total amount of check enclosed    $_____________

Today's Date __________________

Enclosed is my check (made payable to the Centennial Committee) for the following:

________  Copies are $50.00 (includes state sales tax).  Add $4.00 per book for postage and handling.

Name and Address  _________________________________________________________________

_________________________________________________________________

____________________________________   Zip Code _____________

Telephone No.  _______________________________________