NAME BADGE ORDERING FORM 2009

Send by e-mail to:

BEFORE YOU SUBMIT THIS ORDER, SAVE IT TO YOUR COMPUTER IN ITS FINAL FORM

AND SEND IT, AS AN ATTACHMENT, TO YOUR EMAIL MESSAGE.

Express Badges, 38 Citadel Peak Circle NW, Calgary, AB T3G 4E8

For information call (403) 239-2230 or toll free at (800) 260-5040; Fax: (403) 239-7783

www.expressbadges.com

Complete the information below and e-mail to the address above. (Use your “down arrow” OR “Tab” key to move through the table below – you’ll have lots of room since the typing area will expand as required). If you have any questions, give us a call!

NAME BADGE ORDERING FORM 2009

Date Ordered

/

Company Name

Ship Attention To

Address

City/State/Zip

Telephone Number

Special Instructions

NAME BADGE ORDERING FORM 2009

Pricing/Payment Information: If you’d like to use VISA, MasterCard or AMEX, indicate the details below (if you’d prefer to call our toll free phone number is 1-800-260-5040). Unit badge costs are $7.50 with a pin-back attachment or $9.50 with a magnet attachment.

Credit Card Number / Expiry

Shipping Instructions: Badges will be shipped by the most economical way to meet your delivery requirement – just let us know if there is a specific date that you need your badges. Shipping costs by First Class Mail will be about $3.00; Xpress Post costs would be $7.00 (BC, AB, SK, MB) or $11.00 (ON, QC, PEI, NB, NF, YK). Standard production time is 2 weeks – if you need the badges sooner just let us know.

If there is a specific delivery date requested, indicate it in the space to the right.

Name Badge Imprinting Instructions: Type the information needed on the badge(s) under the headings below. If there are any special requirements, make a note in the “special instructions” section above. Ensure that your CIPS membership information is included

NAME BADGE ORDERING FORM 2009

Name Designations (Optional) Company Name (Optional) Pin-back or Magnet

CIPS Membership and Designations (if applicable) Confirmation:

CIPS Membership Designation in good standing (Yes or No)

No./Expiry Date I.S.P.(EATI) ITCP (PATI)

My email address shown below is confirmation that the information above is correct. (Please indicate your email address below)

Email Address:

Note: New CIPS certified members will receive their first badge at no cost as part of the application process. This badge will be sent to you directly and this order form should not be used.