KIM: Kids In Motion

KIDZINMOTION shirt order form

Please fill in the information below. Required fields are noted with an asterisk (*).

Shipping Information

First Name: *	Last Name: *
Street Address: *
City: *	State (or Province): *
ZIP: *	eMail: *
Phone: *
Light Blue golf shirt with white piping (European sizing) $15 Number of Blue: Size in Blue:

Payment Information

All shirt prices include shipping and handling

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Purchase Order #:

KIDZ IN MOTION, INC.
5424 Conway Pointe Court
Orlando, FL 32812

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name of the person registered!

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