Nursing Alumni Jewelry CollectionOrder Form Contact Info First Name Last Name Email Phone Status Select... Alumni Student Faculty/Staff Gift Other Address City State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code Jewelry Selection Payment is separate from this order form. After submitting this information on the following confirmation page, complete your payment by following the link "Pay now by credit card or eCheck." Item Quantity/Price Silver "75" Bead 0 1 / $60 2 / $120 3 / $180 4 / $240 5 / $300 Silver "Duquesne Nursing" Bead 0 1 / $60 2 / $120 3 / $180 4 / $240 5 / $300 Red-Blue Swirl Glass Bead 0 1 / $30 2 / $60 3 / $90 4 / $120 5 / $150 Red-Blue Raised Dot Glass Bead 0 1 / $30 2 / $60 3 / $90 4 / $120 5 / $150 Red-Blue Encased Dot Glass Bead 0 1 / $30 2 / $60 3 / $90 4 / $120 5 / $150 Bookmark 0 1 / $20 2 / $40 3 / $60 4 / $80 5 / $100 Wine Stopper 0 1 / $50 2 / $100 3 / $150 4 / $200 5 / $250 Cell Charm 0 1 / $10 2 / $20 3 / $30 4 / $40 5 / $50 Shipping $ Total $
