Please print this form and mail it with check or money order to:  Alaska Radio Mission, PO Box 988, Nome, Alaska 99762.

In addition to my donation, I am enclosing an additional $__________ to purchase _____ KNOM 30th Anniversary T-shirt(s) at $20.00 each, including Priority Mail.  I understand that due to limited supplies, the color(s) I prefer may not be available.  Sizes:  S (very limited), M, L, XL. (XXL is sold out.)  Colors:  black, navy, purple or royal blue
                                                                                                                  Qty   Size   Color 1st/2nd choice
Name_________________________________________________      ___   ____  ______/______
                                                                                                                 ___   ____  ______/______
Address_______________________________________________      ___   ____  ______/______
                                                                                                                 ___   ____  ______/______
City___________________________________________________     ___   ____  ______/______
                                                                                                                 ___   ____  ______/______
State______  Zip_______________________        Thank you!                                                                          8/01