MadSci T-shirt Order Form

Print and fill-out the information below. Enclose this form with a check or money order to "MadSci Network" for the amount calculated.
Send the completed form to:

	MadSci Network
	P.O. Box 300-735
	Boston, MA 02130

Please enter the number of each size you would like for each shirt.

____ Small

____ Medium

____ Large

____ Extra-large

___________________________________
 
____ Total number of shirts ordered
     @ $20.00 US/each

____ Total enclosed.

Your shipping address:

Name:_____________________________________________

Address: _________________________________________

City: ______________ State/Province: _____________

Zip: ___________  Country: _______________________

Email: ___________________________________________
(enter an email if you desire electronic confirmation
that your order has been received & shpiped).

Shirts will be sent after receipt of payment.
Expect receipt of shirts 2-3 weeks after receipt of order.
Please contact us if you have any questions.