The AMBER stick™
                                                   Order Form


Please send me ________ AMBER sticks.
Members of DCFCCA  $25 each (includes shipping anywhere in MN)
Non Members of DCFCCA $30 each (includes shipping anywhere in MN)

Enclosed is $________________.

Name __________________________________________________________________

Address ________________________________________________________________

City _____________________________________ State ____________ Zip __________

Please allow 2 weeks for delivery.

Mail check or money order payable to DCFCCA to:
DCFCCA-Membership Coordinator
C/O  Hannah Huberty
891 Nina Ct.
Mendota Heights, MN 55118