Nursing:Apricot

Fine Arts:Brown

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Musical Arts: Pink

Vet. Medicine:Gray

Audiology, Medicine, Physical Therapy:Kelly Green

PhD:Dark Blue

Pharmacy:Olive

Law:Purple

We try our best to represent colors & styles of our current trims. Please note printed color blocks will vary from actual velvet color.

The Doctoral Package includes:

• UW-Madison Regalia Gown• PhD Hood with Red lining• 8-sided Black Velvet Tam• Gold Bullion Tassel

School Regalia gown is manufactured in a lightweight, breathable, high quality Black polyester fabric with Red velvet panels and chevrons. UW-Madison Shield “W” crest is embroidered on the left front panel. A pocket slit is on the right side of the gown. Hood with PhD Dark Blue velvet and red lining. 8-Sided Black Velvet Tam with Gold Bullion tassel.

Additional Hood Velvets: Musical Arts, Law, Audiology, Medicine, Vet. Med., Pharmacy, Physical Therapy, Nursing and Fine Arts.

Additional Hood Color Velvets:

$761.70

Official UW-Madison B L A C K R E G A L I A P A C K A G E

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SCHOOL AFFILIATION _____________________________________________ SCHOOL LOCATION - TOWN & STATE ____________________________

Sales Customer’s Professional ________________________________ No. ____________ Signature __________________________________Date _____________________________

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Individual

Street Address

City State Zip

Daytime Phone Best Time To Call

Email address

Individual

Street Address

City County State Zip

Office Phone Best Time To Call

Email address

DOCTORAL GOWN:

Special Doctoral Gown for University of Wisconsin-Madison Gabardine Faculty Gown; right pocket slit included Item code: ACAD.SPUNIVWISCMADISONBLKFACULTYMDL

UNIVERSITY OF WISCONSIN-MADISON MADISON, WI

$468.60

DOCTORAL CAP:

8 SIDED Black Velvet Tam with w/Gold Bullion Tassel

$157.00

$136.10

RICK HANNIG 0890

FAX COMPLETED FORM TO 608.257.9479 Attn: Hard Lines Dept - Academic Attire Purchase

Date needed_____________. If request date is not possible: Proceed - ship when ready Call First

Please allow 6 weeks for manufacturing after the complete order is received in our Champaign Office.

MEASUREMENTS(Please Give All Information Requested)

MALE FEMALE

1. Height with shoes - top of head to floor _______feet________ inches.

2. Chest size - without coat ________________ inches.

3. Shirt sleeve measurement ________________ inches.(Measure from center-back of neck, over the top of the shoulder, and along

the outer arm to the break at the back of the wrist.)

4. Cap size ________________________________ inches.

5. Floor clearance desired ___________________ inches.

(We will provide a 8" clearance if you do not specify.)

6. Personalized initials (if desired; no extra charge) - specify: _____ _____ _____

COST SUMMARY OF ORDER

Gown................................................................................................................$ ___________

Hood ................................................................................................................... ___________

Cap/Tam ........................................................................................................... ___________

Tassel ................................................................................................................. ___________

Other Items: ____________ ................................................................... ___________

____________ ................................................................... ___________

Cost of merchandise ........................................................................... ___________

__________________________________ ...................................... ___________

SALES TAX - your local rate ............................................................ ___________SHIPPING & HANDLING ...................................................................$ ___________

Ground Service (to U.S. 48) $19.95

TOTAL COST OF ORDER.................................................................$ ___________Regalia must be pre-paid at the time of order.

CREDIT CARD OR PURCHASE ORDER

VISA Mastercard Discover

Credit Card No. ___________________________________________________

Expiration Date ___________________________________________________

Name on Card ____________________________________________________

Name exactly as it appears on card

Purchase Order # _________________________________________________

OFFICE USE ONLY: _______________________________________________

ACCESSORIES:

REMARKS & SPECIAL INSTRUCTIONS ______________________________

____________________________________________________________________

____________________________________________________________________

GARMENT BAGS: E-Z Stor Garment Bag $10.40 Nylon Garment Bag $31.70 Carry-All Garment Bag $74.99

HANGERS: Wooden Hanger $1.95 Deluxe Wooden hanger $14.99

Please print legibly

Herff Jones Order No.

Customer No. Customer No.

SPECIAL APPAREL ORDER FORM

DOCTORAL HOOD: UW-Madison

Doctoral Hood -Black Base Standard with Degree Velvet

Choose Your Degree (check an option below):

PhD (Royal Blue) Law (Purple) Vet. Medicine (Gray)

Music (Pink) Pharmacy (Olive) Audiology (Kelly Green)

Physical Therapy (Kelly Green) Medicine (Kelly Green)

Nursing (Apricot) Fine Arts (Brown)