Donation Tier * Please select which donation tier, if you are wanting to provide a "Business Donation" please put how much in the comments $20 $40 (Thank you socks) $60 (Thank you T-shirt) $80+ (Thank you socks and T-shirt) Name * First Name Last Name Phone (###) ### #### Email Address Address 1 Address 2 City State/Province Zip/Postal Code Country Shirt Size If you need an additional size, please leave comment below or if you do not want the item Small Medium Large X-Large Sock Size If you wish to no receive item, please leave comment below Small Medium Large Pick Up or Delivery If you do not wish to receive items, please disregard Pick Up Deliver (additional $10) Additional Comments Thank you! Mailing Address:425 Long Ave. Roxboro NC 27573
