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Quantity	Item	Unit Cost	Total Cost
	Membership package(s) which include membership card, book and "pack rat" t-shirt	$25.00	$
	Book(s)	$18.00	$
	T-Shirt(s) (add $2.00 for XXL)	$10.00	$
	Membership Card(s)	$  2.00	$
	Subtotal:		$
	Shipping and handling:		$    2.00
	Total amount of my check or money order:		$

Please fill out the following information: First name: Last name: Street Address: City: State: Zipcode: E-Mail Address: Phone Number: ( )    - Please enter shirt size(s) (M, L, XL, XXL) and comments here:

SHIP TO:    Check box if address is the same as above. First name: Last name: Street Address: City: State: Zipcode: E-Mail Address: Phone Number: ( )    -   Press to start over. Please print this order form and mail to below address. Your purchases will be mailed out immediately upon receipt of your check or money order. SEND TO: Panacea 2170 The Alameda San Jose, CA   95126 Thank you for your order.