Regional Vice President Medal Request

RVP Medal Request Form

Name

Prefix First Last Suffix

Phone(Required)

Region

Date Award Needed (Typical turnaround is 14-21 days. See below for details.)(Required)

Recipient Information

1st Recipient Prefix

1st Recipient Name

Prefix First Last Suffix

1st Recipient Post Affiliation

1st Recipient Comments

2nd Recipient Name

Prefix First Last Suffix

2nd Recipient Post Affiliation

2nd Recipient Comments

3rd Recipient Name

Prefix First Last Suffix

3rd Recipient Post Affiliation

3rd Recipient Comments

Shipping Information

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Additional Information or Instructions

Shipping and Handling (check one)

Express Shipping 3-5 Days (in addition to two week preparation time

Ground Shipping 7-10 Business Days

After an order is placed it takes approximately 7 days for processing, production and engraving, then your order will ship based on your choice of the two shipping options (Express Shipping or Ground Shipping).

To confirm receipt of your RVP Medal request, please contact Otis Carter, SAME Logistics & Administrative Services Specialist, ocarter@same.org, or 703-549-3800 ext. 114.

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