American Fisheries Society

Certificate Award Order Form

Please send your request for a certificate to: Gail Goldberg, AFS Unit Services Coordinator, ggoldberg@fisheries.org.

Please allow for a two to three week turnaround time.

Type of Certificate:
Chapter
Section
Division
Past President
Student Newsletter Editor
Newsletter Certificate
Award of Merit
Secretary/Treasurer
Best Student Paper:
Outstanding Chapter
Distinguished Service
Best Paper:
Award of Excellence
Other. Please Specify:
Certificate Award Information:

Name to Be Place on Certificate:
City, State, Year Where Presentation Will Be Made:
Date Presentation Will Be Made:
Dates of Service for Award Recipient:
UPS Shipping Address:
First Name:
Last Name:
Address:
Address:
City:
State:
Zip/Postal Code:
Country:
Please provide for Society use only:
Phone:
Fax:
Email:

Billing/Invoice Address:(if different than the shipping address)

Name:
Address:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Please provide for Society use only:
Phone:
Fax:
Email:
Ordered By:
Member Name:
Subunit Name:
Member Number:

COST BREAKDOWN:

Cost of certificate: $5 each

Cost of Plaque: $15 each

Cost of Shipping and HandlingContinental US: $5 per award certificate

Cost of Shipping and Handling Outside Continental US: Varies

TOTAL COST FOR ONE DOMESTIC (U.S.) ORDER IS $25

Method of payment (check one)

Please bill me
Purchase Order Number
Visa
MasterCard
Credit Card Number
Expiration Date
Name as it appears on Credit Card

Certificate Award Order Form

Billing/Invoice Address:(if different than the shipping address)

COST BREAKDOWN:

Method of payment (check one)

Calendar / Meetings