Date______

PLEASE PRINT

Name: Dr., Miss., Mrs., Ms.

Address:

City:

State/Prov./Country: Zip/Postal:

Daytime Telephone (Include Area Code):

E-mail:

Chapter: State Organization:

Telephone: 1.888.762.4685, ext. 125 (Toll Free for U.S. & Canada)

1.512.478.5748, ext. 125

Fax: 1.512.474.2494

E-mail:

Mail: The Delta Kappa Gamma Society International

P. O. Box 1589

Austin, TX 78767-1589

ONLINE STORE: www.deltakappagamma.net

■ Order Society jewelry and initiation paraphernalia from

Award Concepts Inc.

www.awardconcepts.net

Telephone: 1.800.659.7801

■ Additional supplies and gift items are available from

Bells Select

www.imprintmall.com/deltakappagamma

Telephone: 1.888.333.4354

Prices Expire June 30, 2010

Item # / PUBLICATIONS / Quantity / Unit Cost / Total Cost
5420 / Constitution/International Standing Rules, 2006 One / 2.50
5428 / CD (updated to 2008) / 5.00
5705 / Handbook, 2004 CD (updated to 2008) / 5.00
5320 / Ceremonies, 1994 / 2.00
9321 / Orientation Guide / 1.00
6000 / Our Heritage, Volume I – by Eunah Temple Holden / 26.00
6010 / Our Heritage, Volume II – by Eunah Temple Holden / 16.00
9402 / Guidelines for State/Chapter Finance Committees – 8 page booklet / No Charge
5410 / Guidelines for State and Chapter Communications Committee Chairs / 2.00
5415 / Guidelines for Chapter Membership Committee Chairs / 2.00
5425 / Guidelines for Chapter President / 2.00
5427 / Guidelines for Chapter Treasurer / 2.00
6445 / Society Graphics – Society logos to enhance your publication CD / 2.50
Item # / PROGRAM MATERIALS / Quantity / Unit Cost / Total Cost
6300 / Program Resource Guide 2006–2010 CD w/printed version / 20.00
6310 / “Passion for Learning – The Essence of Growth” CD only / 5.00
6470 / “Our Founders” (Power Point Presentation, Photos & Script) CD / 10.00
5990 / Society Song Card / .50
6410 / “Commitment to Music” by Betty Oswald (music activities for meetings) / 4.00
6341 / “The Expansion Story” DVD / 12.00
(An International History of Society Expansion/approx. 14 minutes)
6370 / “From the Sparkle of the Past to the Brilliance of the Future” DVD / 12.00
(A visual presentation celebrating the Society’s first 75 years/approx. 13 minutes) / 12.00
Item # / MEMBERSHIP SUPPLIES / Quantity / Unit Cost / Total Cost
5750 / Invitations to Membership/envelopes 5 per set / sets / 4.00
5900 / Membership Certificate – Chapter (New Initiates) / 2.50
5930 / Membership Certificate – State Organization Honorary / 8.00
5880 / Membership Announcement Cards/envelopes 5 per set / sets / 4.00
9326 / New Member Information Kit (NEW DESIGN) One / 7.00
9327 / 6 per set / sets / 35.00
(Membership Supplies continued on back) / TOTAL / $
Item # / MEMBERSHIP SUPPLIES (Continued) / Quantity / Unit Cost / Total Cost
9346 / Rose Pocket Folder (NEW ITEM) One / 1.50
9347 / 6 per set / sets / 8.00
5980 / Official Initiate Register / 15.00
5940 / ALERT! Membership Dues Reminder Postcards 10 per set / sets / 2.00
5010 / “Member on the Move” One / 1.00
5011 / (Transfer Form/TR-A and information in a ready-to-mail envelope) 6 per set / sets / 3.00
Shipping & Handling Charges for Purchased Materials
Allow 2-3 days from the date the order is received to process and ship
SUB-TOTAL Page 1
SUB-TOTAL Page 2
TOTAL / $
Texas Members Only .0625 TAX
Shipping & Handling Purchased Materials
TOTAL
Purchased Materials / $
Standard Mail
(USA Only) /
Priority Mail
(USA Only) /

International Mail

Packages weighing over 4 lbs are shipped as Priority Mail due to USPS rates

5 – 10 Day Delivery / 2 – 3 Day Delivery / Delivery time varies
Up to $32.00 $4.00 / Up to $32.00 $9.00 / Orders from outside of the U. S. must be purchased
$32.01$60.00 $6.00 / $32.01$60.00 $13.00 / with a charge card. (Sorry, no checks or money
$60.01$100.00 $8.00 / $60.01$100.00 $19.00 / orders are accepted from outside of the U.S.) Actual
$100.01$150.00 $10.00 / $100.01$150.00 $21.00 / postal charges will be added to your credit card
$150.01$200.00 $12.00 / $150.01$200.00 $27.00 / account plus $3.00 for handling.

W = Available for download at www.deltakappagamma.net

Item # / FORMS / Quantity / Item # / FORMS / Quantity
9306 / Society Order Form (Form #1) W / 9303 / Recommendation for Membership (Form 11)W
5890 / Membership Card (3 per sheet) / 9210 / Application – Cornetet Award for Prof. Dev.W
5730 / Initiate Card W / 9212 / Application – Cornetet Prof. Dev. Seminar W
5330 / Change of Address Card W / 9312 / Recommendation Form for International
Achievement Award (Available Aug–Feb) W
6351 / Reinstatement Card W / 9313 / Recommendation Form for Appointment to International Committees
9304 / Transfer Application (Form TR-A) W / (Available Jan–June, even–numbered years) W
9301 / Chapter President Letter for Membership / 9302 / New Chapter Charter Request (Form 21) W
Transfer to New Area (Form TR-19) W /
9314 / Recommendation Form for Nominations: Intl. Officers, Elected Committees and Educ Fndtn
5430 / Death Report (Form 6) W / (Available Apr–Oct, odd-numbered years) W
6590 / Contribution Form (Form 43) W / 9305 / Jewelry Order Form (Award Concepts, Inc.) W
6620 / Report of Dues and Fees (Form 18) / 6305 / Paraphernalia Order Form (Award Concepts, Inc.) W
6630 / Report of Members Dropped (Form 18-A) / 9300 / Bells Select Product Guide W
Item # / BROCHURES / Quantity / Item # / BROCHURES / Quantity
9307 / DKG Educational Foundation W / 9336 / Marketing the Society (NEW ITEM)
9325 / Eunah Temple Holden Leadership Fund W / (Prospective Members – You & Us))
9308 / Golden Gift Fund W / 9322 / Society Membership (NEW ITEM)
9309 / International Speakers Fund W / (Get Involved – One & All)
9332 / International Expansion W / 9310 / Scholarships (International) W
9334 / Emergency Fund W / 9311 / World Fellowships W

TOTAL # of Forms/Brochures

Shipping & Handling Charges
Forms/Brochures / 1–25
$2 / 26–50
$4 / 51–75
$6 / 76–100
$8 / 101-125
$10 / Add $2.00 for each
additional batch of 25
Payment Method: American Express MasterCard Visa
Check/Money Order (U.S. Funds only)
Payable to The Delta Kappa Gamma Society International
Card Number: /
/ Exp. Date:
Print Cardholder’s Name as Shown on Card: ______
Billing Address if Different from Shipping Address: ______
City: ______
State/Prov./Country: ______Zip/Postal: ______/ Shipping & Handling Forms/Brochures
TOTAL
Purchased Materials / $
GRAND TOTAL / $
OFFICE USE ONLY
Shipping & Handling
International
GRAND TOTAL INTERNATIONAL / $