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PAC T-Shirt and Sweatshirt Order Form


Please print this form and mail with your check or money order payable to:

PAC
P.O. Box 92644
Long Beach, CA 90809-2644

Please allow 3-4 weeks for delivery

Polo Shirt Total # of T- Shirts Totals
Blue with white PAC emblem s __ m__ l__ xl__ xxl__ @ $15 ea. = _______
White with blue PAC emblem s __ m__ l__ xl__ xxl__ @ $15 ea. = _______
Sweat Shirt Total # of Sweat Shirts Totals
Blue with white PAC emblem s __ m__ l__ xl__ xxl__ @ $16 ea. = _______
White with blue PAC emblem s __ m__ l__ xl__ xxl__ @ $16 ea. = _______

 

Subtotal =
Shipping & Handling =     6.00    
Grand Total _______

Your Name:

Address:

City, State, Zip:

Phone # (in case we need to contact you):

 

 



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Dedicated To Children With Cancer & Blood Disorders


Parents Against Cancer, Inc.
P.O. Box 92644 ·Long Beach, CA 90809-2644

Jonathan Jaques Children's Cancer Center
Miller Children's Hospital, Long Beach Memorial Medical Center

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General Disclaimer: This web site and any links herein are provided for informational purposes only and are not intended to render medical advice.  If you suspect your child has a health problem, you should consult your health care provider.