Please complete the order form below. When you click on submit the form will be sent to the insignia coordinator, and you should be provided with a confirmation of your information entered. Please print a copy of the confirmation page to include with your payment. You may also want to print an additional confirmation page for your own records. Mail payments to the insignia coordinator AFTER you receive a confirmation email from the insignia coordinator that your order was received. The insignia coordinator will notify you of any shipping costs to be added to your payment total.
Payments with a copy of the confirmation order page should be sent to:
Myrinda Grantham
Box 921812
University of Louisville
Louisville, KY 40292
Name
Chapter
Email address
Phone number
Shipping Address
Date of Order
Item # Item Cost/item Quantity Total Cost
Total Order