

This list supersedes all previous years -- only orders received on current requisition forms will be honored. You will need to print this form, complete it and then send it along with your check to the address below.
Important!! Please make certain that you include the shipping cost of $4.50 listed in the order form below. Your order could be greatly delayed if you do not..
| ITEM | PRICE | QUANTITY | AMOUNT |
|---|---|---|---|
$160.00 | . | . | |
| Miniature Emblem Medal (Hereditary Membership)* | $85.00 | . | . |
| Large Emblem Medal (Associate Membership)* | $160.00 | . | . |
| Miniature Emblem Medal (Associate Membership)* | $85.00 | . | . |
| Emblem Medals 14-16K Gold (3-4 Month Delivery Time) | On Request | . | . |
| Hereditary Replacement Ribbon -Large Medal | $20.00 | . | . |
| Hereditary Replacement Ribbon -Miniature Medal | $20.00 | . | . |
| Associate Replacement Ribbon -Large Medal | $20.00 | . | . |
| Associate Replacement Ribbon -Miniature Medal | $20.00 | . | . |
| Officer Neck Ribbon | $20.00 | . | . |
Sold Out | . | . | |
$9.00 | . | . | |
$9.00 | . | . | |
| Necktie (All Silk) | $34.00 | . | . |
| Bow Tie (All Silk) | $34.00 | . | . |
$15.00 | . | . | |
$15.00 | . | . | |
MOLLUS T-Shirt (Indicate Size: S, M, L, XL, XXL) | $15.00 | . | . |
$5.00 | . | . | |
| Certificate of Hereditary Membership (8 1/2" x 11") | $25.00 | . | . |
| Certificate of Hereditary Membership (17" x 19") | $65.00 | . | . |
| Certificate of Associate Membership (8 1/2" x 11") | $25.00 | . | . |
$45.00 | . | ||
$65.00 | . | . | |
| Gold Plated Challenge Coin | $25.00 | . | . |
| ROTC Medal with Ribbon Bar and Certificate | $35.00 | . | . |
On Request | . | . | |
$25.00 | . | . | |
| MOLLUS Note Cards (Pack of 25) | $6.00 | . | . |
| MOLLUS Post Cards (Pack of 10) | $1.00 | . | . |
$3.00 | . | . | |
| MOLLUS Recruiting Brochures (pack of 10) | No charge (Pay Shipping Only) | . | . |
| . | . | SHIPPING | $4.50 |
| *Gold plated over Bronze | . | TOTAL | . |
Send Orders and payments to: Joseph Coleman, Ed.D., 85 Beddington Lane, Strasburg, PA 17579-1451.
Check should be made payable to: "MOLLUS Commandery-in-Chief"
Name:______________________________________________, Insignia Number __________________**
Address:_____________________________________________________________________________
City/State/Zip_________________________________________________________________________
Email Address: _______________________________________________________________________
Questions on supplies and orders should be sent to Joseph Coleman at drjtc30@comcast.net
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** If you do not remember your Insignia Number, contact Keith G. Harrison, PCinC at pcinc@prodigy.net

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