Thank you for supporting Cooper and his family.  

Each T-shirt costs $10 plus shipping.  

Please print this form and send it with your check to:

P.O.Box 2752
Cathedral City, CA 92235-2752 

Please make checks payable to Cooper Somerville.  All proceeds will go directly to Cooper's fund.  No cash please.  Your order will be sent out as soon as possible.  Thank you again.

How many of each size?

XXL XL
Large Medium

Total number of T-shirts:       

Amount enclosed (at $10 a T-shirt plus $5 shipping):
          

Would you like your name listed on Cooper's Sponsors page for your contribution?

Yes    No

Any comments? Enter your comments in the space provided below:

Where would you like the T-shirt(s) sent:

Name
Address
City
State
Zip
E-mail
Telephone

Chris Hipsher.
Cooper's Corner.
Revised: June 23, 2001 .
Hosted by www.Geocities.ws

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