Philadelphia Athletic Charities Track Club
                                Merchandise Order Form
__________________________________________________________
Greater Philadelphia Track Club Order Form
Add $1.50 for every  item ordered to handle shipment and handling to U.S.
addresses only.
If you would like to order it and pick it up from Chuck Shields in
person,let him know.
 Please circle the size(s) ordered and Please Print Info Section.

Name_______________________________________________________

Address ___________________________________________________________

City_____________________________   State______________   Zip_________________

Phone__________________________________  E Mail____________________________________________

                                                                                                                                       Price each               Quantity    Shipping    Amount
      GPTC Race Singlet          S            M          L          XL            $16                   ______   ______   ______
Please make check payable to  Greater Philadelphia TC and mail form to :

Greater Philadelphia TC/Chuck Shields
1500 Ferndale Rd
Abington,  Pa   19001

Sorry, credit card ordering is not available. Allow 2-3 weeks for
delivery
if your size is in stock