Lone Star Leadership Academy - Patch Order Form

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Dear Lone Star Leadership Academy Alumnus, Congratulations on successfully completing a Lone Star Leadership Academy program. Lone Star Leadership Academy patches for each program location are available for you to order.

Lone Star Leadership Academy – Dallas/Fort Worth patch The background color is white. The Texas is red with a blue outline and white letters. “Lone Star Leadership Academy” and the outside border are black.

Lone Star Leadership Academy – Austin/San Antonio patch The background color is white. The Texas is blue with a red outline and white letters. “Lone Star Leadership Academy” and the outside border are black.

Lone Star Leadership Academy – Houston/Galveston patch The background color is white. The Texas is silver with a blue outline and red letters. “Lone Star Leadership Academy” and the outside border are black.

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The cost for each patch is $11.00 (includes shipping). Each circular patch size is 4” in diameter. ________________________________________________________

Lone Star Leadership Academy - Patch Order Form To place your order, MAIL this form (phone orders are not accepted) along with a check, money order or credit card information OR FAX this form along with credit card information to: Education in Action Attn: Rhonda Richardson P.O. Box 2285 Keller, TX 76244 817-562-4957 Fax: 817-562-2058 Your Name:

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Mailing Address: ___________________________________________________ ____________________________________________________ Phone Number: ____________________________________________________ Quantity Dallas/Fort Worth Patch

________ X $11.00 = ________

Austin/San Antonio Patch

________ X $11.00 = ________

Houston/Galveston Patch

________ X $11.00 = ________ ($1.00 included for shipping.) TOTAL ENCLOSED:

________

 Check/Money Order (made out to Education in Action) OR  Credit Card: Visa MasterCard Credit Card #: _____________________________ Expiration Date: ____________ CVV# _________ Name on Card: ____________________________ Signature: _______________________________ Billing Address:

Same as Mailing OR ______________________________________________