Pin Order Form

Pin Order Form As an Angels in Adoption® Program honoree, you will receive one complimentary handcrafted “Angel Pin” on September 26th at either the Congressional Breakfast or Luncheon. For example, whether you were honored as Mr. Jim Jones, Mr. Jim and Kathy Jones, or Jim Jones’ Adoption Associates, you will receive only one pin. Again, all Angels receive one pin. We are acutely aware of the significance of these pins, and are proud of what they represent for our Angels. Over the years, we have watched Angels wear their pins as a badge of honor and they serve as a wonderful conversation piece. We have imposed a limit on the pins because of the rising cost to produce these pins by Jeweler, Mignon Faget. The pin costs $60.00 (includes cost of production and shipping and handling). We encourage you to order as many pins as you would like at the rate charged to us by Mignon Faget. We will not add any additional fees to your purchase. For more information, please contact Lindsey at [email protected] or (202) 544-8500. Name of Angel:________________________________________________________________________ Shipping Address: ______________________________________________________________________ City:__________________________________ State:_____________ Zip:__________________________ Phone:________________________________ Email:_________________________________________ Payment Method: Name on Card:_________________________________________________________________________ Company on Card (if applicable):__________________________________________________________ Billing Address:________________________________________________________________________ City:__________________________________ State:_____________ Zip:__________________________ Number of Pins_____ X $60.00 = $________ TOTAL to be charged: $________ □ check enclosed □ charge my credit card Card Number_________________________________ Expiration Date_______________ Card Type: VISA / MasterCard /AMEX / Discover card security code_________________ Signature________________________________________________________________