Eyes of Kahless - Order Form

Please input your Name and E-mail address:

I need to order following awards;  Eyes of Kahless   0 1 2 3 ,   Eyes of Kahless Clusters   0 1 2 3 4 5

Method of delivery shall be;
    I will pick them up personally. Note: Rex Moffett is making the awards for the StarFire Region and he lives in Vacaville CA.
    I want to pick them at the next event I attend, which will be;
           
    Please mail them to the address below; (there is a shipping fee involved).
         My Mailing address;
           

    Notes: (also include any comments about this form - suggestions are welcome
   

Note: We will verify your order with our records before the order is processed.
You may not order more awards than you have earned.

Just a note before you submit this form. There is some validation that is done before this form is sent to StarFire Command.
If there is an error you will get an error report. To make a correction DO NOT use the Return to Form link at the bottom.
Instead use your browser's Back button. This way the data on your form is still intact otherwise the Return erases your data.