EmailMeForm
VA Employee Association
Please verify your information before submitting this form. Most fields on this form are required. Select NA or 0 for those areas not applicable.
You can pay via Venmo, CashApp, Cash, or PayPal.
Venmo: @Dianne-Ricks
CashApp: $DeeWayRicks
Zelle: 504-430-3389
PayPal: @DianneWay or dwayricks@yahoo.com
Questions: dwayricks@yahoo.com or 504-430-3389
Name
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First
Last
Floor/Unit
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Cell Phone/Work Phone #
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Email
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Gold Cotton Shirt Size: Price includes shirt and logo. Name on shirt is an additional $5.00. PLEASE VERIFY YOUR SHIRT SIZE BEFORE SUBMITTING ORDER FORM!
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Small ($23.00)
Medium ($23.00)
Large ($23.00)
XL ($23.00)
2XL ($26.00)
3XL ($26.00)
4XL ($30.00)
# Shirts Ordered
Name you want on shirt if applicable. Name is $5.00 extra
Please double check this information for accuracy before submitting the form.
Total Amount Due: (Shirt cost + Name, if applicable)
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Please indicate your Payment Method
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Venmo
CashApp
PayPal
