Print the form below and write in your selections.
Please mail payment for purchases from this organization to:
NCPA, College of Pharmacy
The University of Texas at Austin
1 University Station, A1900
Austin, TX 78712-0120
USA
(Note: All prices include shipping and handling charges. T-shirts are in adult sizes.)
Questions about the items may be sent to The College of Pharmacy. Please include the name of the organization selling the item in your message.
| Item Description | Item Price | Item Options |
|---|---|---|
| NCPA Logo Navy T | $15 | Select Size: S M L XL XXL |
| NCPA Logo Burnt Orange T | $15 | Select Size: S M L XL |
| Baseball Hat in Khaki | $18 | |
| Baseball Hat in Blue | $18 | |
| Texas Pharmacy Pin | $5 |
Please enter the number of items you want to purchase of each option. If none, leave blank.
Small Size NCPA Navy T | ________ |
Medium Size NCPA Navy T | ________ |
Large Size NCPA Navy T | ________ |
Extra Large Size NCPA Navy T | ________ |
Extra-Extra Large Size NCPA Navy T | ________ |
Small Size NCPA Burnt Orange T | ________ |
Medium Size NCPA Burnt Orange T | ________ |
Large Size NCPA Burnt Orange T | ________ |
Extra Large Size NCPA Burnt Orange T | ________ |
Baseball Hat in Khaki | ________ |
Baseball Hat in Blue | ________ |
Texas Pharmacy Pin | ________ |
| Total for t-shirt(s) - $15 each | ________ |
| Total for baseball hat(s) - $18 each | ________ |
| Total for pin(s) - $5 each | ________ |
| Total amount due | ________ |
Please submit checks payable to NCPA; and, provide the address where the items are to be shipped:
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