San Francisco Bay Area Fraternal Order of Police

California Lodge 17 Challenge Coin and Lapel Pin Order Form

(please print legibly) Name: Shipping Address: City, State, Zip Home Phone Number: Cell Phone Number:_____________________________________ E-mail Address: Number of Challenge Coins @ $10.00 each__________________ Number of Lapel Pins @ $5.00 each________________________ Total Order plus $2.00 postage and handling__________________ Mail Order Form and check payable to S.F.Bay Area F.O.P to: Michael J. Wozniak SFBAFOP17 Post Office Box 2221 Oakland, California, 94621-0121