REGINA SWIMMER'S
"LIFE GOES ON"
CD Order Form




Name:  ____________________________________________________________

Address:  __________________________________________________________

City:  _______________________  State:  ________   Zip:  ______________

Email:  _______________________________ 
(In case there are questions about your order)

Quantity ordered _________



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SEND CHECK OR MONEY ORDER FOR $15.00 (US) per CD
 PAYABLE TO:
R & E Swimmer

P.O. Box 2354
Cherokee NC,  28719