Membership Information

Shirt Order Form

Fill out this form and then print. Mail or fax the order form to:
The Society of Teachers of Family Medicine
11400 Tomahawk Creek Parkway, Ste.540
Leawood, KS, 66211
913-906-6000 · 800-274-2237, ext. 5404
Fax: 913-906-6096, mruhl@stfm.org


Note: Some shirts are in limited supply, call first to see what is in stock!
800-274-2237 ext. 5404
Shirt Qty Price Each Total Price
Subtotal:
Click to calculate shipping (10% of order total) Shipping/Handling: 
Grand Total:

Bill To
Name:
Company:
Address1:
Address2:
City, State, Zip:
Phone:
E-mail address:
Enclosed is my check, made payable to STFM (US funds only).
Charge: MasterCard VISA American Express
Account Number:
Expires:

Signature: ________________________________________________________

Ship To
Name:
Company:
Address1:
Address2:
City, State, Zip:
Phone:
E-mail address:
  
{Text}
Member Information