Order Form Item Price Quantity Total Cost Gold Trophy $474 Silver Trophy $474 Bronze Trophy $474 Grand Trophy $650 Name Personalization $40 Certificates $65 Awards Journal - Year: $50 Winners Reel : Year: (2007 & 2008 not available, please visit Winners Showcase at www.effie.org) $200 $0 $0   TOTAL Shipping Information * Name Company * Address * City * State        * Zip * Phone   Fax * Email * FedEx Account Number Please allow 3-4 weeks for delivery. Order Details for Trophies and Certificates Trophies and Certificates always include the campaign title and the brand/client. We can credit up to two agency names, both of which must have been listed as a contributing agency at the time of entry. Name personalization is optional. If ordering multiple trophies/certificates with name personalization, please enter all names seperated by a comma. EFFIE Year Campaign Name Type of Award None Gold Silver Bronze Personalization Information Client Company What agency(s) would you like to credit? (2 max)     All orders must be prepaid. You may also print this form out and fax it with your credit card information/ payment to: New York American Marketing Association, 116 East 27th Street, 6th Floor, New York, NY 10016. Phone (212) 687-3280 ext. 225; Fax (212) 557-9242. When faxing in your order, include your credit card number, expiration date and security code to complete the order. Please make all checks payable to: New York AMA