Student Care Package Order Form
Please Print and Complete the Form Below

Family Member Information
Name: _________________________
Address: _________________________
_________________________
Phone: _________________________
SDSM&T Student Information
Name: _________________________
Birth Date: _________________________
Local Address: _________________________
_________________________
Phone: _________________________

Order Information
Please Check the occasion(s) you wish to send and write the theme you prefer for each occasion:
Occasion Theme Order Deadline
Must be received by:		 Price Total
Thanksgiving __________________ November 14, 2002 $20.00 ____________
Valentine's Day __________________ February 7, 2003 $20.00 ____________
Saint Patrick's Day __________________ March 10, 2003 $20.00 ____________
Holiday Package* Indicate themes above October 25, 2002 $55.00 ____________
Birthday/Special __________________ Delivery within 24 hrs of order $20.00 ____________
Fall Welcome Back __________________ September 30, 2002 $20.00 ____________
Spring Welcome Back __________________ January 2, 2003 $20.00 ____________
Total Package* Each item included
above.		 October 15, 2002 $110.00 ____________
Fall Finals Week (Fruit, cheese, crackers,
other healthy snacks.)		 December 9, 2002 (AWE) $12.00 ____________
Spring Finals Week April 28, 2003 (AWE) $12.00 ____________
Total Package Plus Finals* Each item included
above.		 October 15, 2002 $130.00 ____________
Other Special Occasion __________________ Delivery within 24 hrs of order $20.00 ____________
Total $___________
6% sales tax $___________
Grand Total $___________
*Holiday Package includes: Thanksgiving, Valentine's Day, and Saint Patrick's Day Occasions.
*Total Package:  Holiday Package as well as Birthday, both Fall and Spring Welcome Back.
*Total Package Plus Final includes: Total Package as well as both Fall and Spring Finals Week.
*Other Special Occasion is not included in either of the Total Packages.

Message you would like on the card:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Check or Money Order
Credit Card       Visa or Mastercard
Name on Credit Card (please print): __________________________________
Credit Card Number: ______________________ Expiration Date: __________

Signature: _________________________________ Date: ________________

Thank you for your Order!

Complete order form and return it with payment to:

SDSM&T University and Public Relations - O'Harra Building 208
501 East Saint Joseph Street, Rapid City, SD 57701
(800) 544-8162, ext. 2554 -- (605) 394-2554 -- (605) 394-6177 FAX
info@sdsmt.edu -- www.hpcnet.org/sdsmt/care