Gesher Galicia, Inc.

14 Years of The Galitzianer CD

Order Form

Please print this blank form, complete it by hand, and mail it with your payment to the address below. If you pay online by PayPal, you may instead include all of the required information in the Notes section of your PayPal order (Use PayPal link below).

Name: __________________________________________________________

GG Member Number: _________

Postal Mailing Address: ___________________________________________

________________________________________________________________

Phone Number:      ________________________________

Email Address:       ________________________________

Ordering and Payment Instructions

For Current GG Members (Dues Paid):            For Non-Members*:

U.S. and Canada                    $22                              U.S. and Canada        $42

Other Countries                      $24                              Other Countries          $44

Payment includes Shipping $2 U.S. and Canada, $4 Other Countries.

Payment Options:

Check – In US$ on a US Bank – payable to Gesher Galicia, Inc.

Money Order – In US$ – payable to Gesher Galicia, Inc.

Cash – In US$

PayPal – Click link for specific instructions.

Send check, money order or cash to:

Leon Gold

c/o Gesher Galicia, Inc.

P.O. Box 1674

Goleta, CA 93116-1674 USA

*Members of Gesher Galicia pay dues annually. See our membership web page for more information. If you wish to join or renew GG now and be able to order a CD at the member price, you may make one payment for the total cost of your dues and the CD. Print and send your completed GG membership form and CD order form to the above address. If using PayPal, you may include all required information on your PayPal order form or, if too detailed, send the GG Membership Form separately to the above address.