NAME BADGE

 

 MEMBERS ONLY, PLEASE

To join, click here

 

Flying Samaritans, Los Amigos Chapter

BADGE ORDER FORM

Date:

Please print or type clearly your name as you wish it to appear on your badge.

 

NAME:

Would you like a pin or magnet on the back of your badge? This is what attaches the badge to your clothing (in case you were wondering.)

Please select one option:  PIN  ($5.00)   MAGNET  ($6.00)

 

Add $1.00 for packaging and postage if you would like us to mail the badge to you.  Otherwise it will be held until the next membership meeting.

 

SAM'S SPECIALTY:  Specialty will be included on the badge in your choice of English or Spanish.

                              English                   -  or  -              Spanish:    

Chiropractor Quiropráctico   or Quiropráctica (fem.)
Dentist Dentista
Dental Assistant Asistente Dental
Dental Hygienist Técnico Dentista  or Técnica Dentista (fem.)
Doctor Médico  or  Médica (fem.)
Nurse Practitioner Enfermero Practicante or Enfermero Practicante (fem)
Pharmacist Farmaceutico  or Farmaceutico  (fem)
Physician Assistant Asistente Médico  or  Asistente Médica (fem)
Pilot Piloto
Registered Nurse Enfermero Registrado or Enfermera Registrada (fem)
Support Staff (helper) Personal de Apoyo
Translator Intérprete
Other 

 

     Complete the above form, print it and mail with a check or money order (no cash, please) to :

The Flying Samaritans, P. O. Box 13513, Phoenix, AZ  85216.