POLK COUNTY BAR ASSOCIATION

LAWYER PICTORIAL DIRECTORY

Order Form

I would like to order  ______  copy(ies) of the Polk County Bar Association Lawyer Pictorial Directory.

____________________________________________________________________

Name

____________________________________________________________________

Address

____________________________________________________________________

City                                                                  State                Zip

____________________________________________________________________

Phone                                                               E-Mail

                                                            _______________________________________

                                                            (signature)

 for the following cost:

a)                  $18 per directory incl. shipping and handling for current members of the Polk County Bar Association (you can join now and take advantage of this reduced cost); or

b)        $23 per directory incl. shipping and handling for non-members of the Polk County Bar Association.

Please send this form and your payment to the

Polk County Bar Association

521 E. Locust Street, Suite 302

Des Moines, IA 50309

               Polk County Bar Association Membership Form