Text Box:   Text Box: Wythe County Genealogical and Historical Association P. O. Box 1601 Wytheville, Virginia 24382   Phone: 276-228-2445 Email:  wythecogha@va.net Website:  www.wythecogha.org Date:  __________________ Ship to: Name:                   ___________________________ Street Address:   ___________________________ City, State, Zip:  ___________________________ Phone:                ___________________________ Email:                 ____________________________  

Text Box: Your Name:         ___________________________________________ Street Address:    ___________________________________________ City, State, Zip:  __________________________________________________ Phone:                __________________________________________________ Email:                 __________________________________________________

Text Box: Ship To:   

Text Box: If you are placing an order for a shirt/shirts please indicate size/sizes on the order form. T-Shirt: $13 -- Sizes:  S, M, L, XL, XXL Sweatshirts: $18 -- Sizes:   M, L, XL Denim: $26 -- Sizes:  M, L, XL

Text Box: Print out this form, fill it out and mail to the address indicated. FOR MAIL-IN ORDERS ONLY---CHECK OR MONEY ORDER

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Please make checks payable to:
Wythe Co. Genealogical and Historical Association

Thank you for your order!

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