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HONOR REGALIA

To place an order for the LAE Medallion it will cost $10.50 each, plus a shipping and handling fee of $7.00 for each Medallion. The total cost of the Medallion will equal a total of $17.50 each; a order needs to be placed ahead of time so that the medallion will be shipped to Corbin Campus at the time of the distribution prior to graduation.

Print and Submit mail with payment:

Name:______________________________________Date:_________________

Address:______________________________________________________________________________

Phone Number:______________________________Email:_____________________________________

Campus:____________________________________Date of graduation:__________________________

Student ID Number:__________________________Number of Items ordered:_____________________

Amount enclosed $:___________________________Method of Payment:_________________________

Note: We accept checks or money orders

Please make payable to: Lambda Alpha Epsilon-Corbin

Mail order form and payment to:

Lambda Alpha Epsilon-Theta Gamma Epsilon-Corbin

Eastern Kentucky University

One Pennington Way

Corbin, Ky. 40701

Items Requested:

Lambda Alpha Epsilon Medallion $10.50 each.

Quantity requested _______Amount Enclosed $ ________ Total Enclosed $ ________+ $7.00 shipping and handling.