PUBLICATION ORDER FORM

Please enclose a check or money order for the total made payable to:
The Queens Historical Society
143-35 37th Avenue
Flushing, N.Y. 11354

MEMBERSHIP SHIPPING________ membership discount - 10%

Gift or Book No.	Gift or Book Title	Quantity	Price	Membership Discount	Shipping/ Handling	Total
Total Enclosed:

 

Name: _________________________________________________

Address: _________________________________________________________

City, State,_____________________________________Zip code:___________

Phone (Day): __________________________________