Poster Orders

Poster Order Form

Please print this form and circle the year of the poster(s) to be ordered and indicate the quantity and total.

Year	Quantity	Total
1988 Poster	___@ $20.00 each—2nd Edition	________
1989 Poster	___@ $20.00 each	________
1990 Poster	___@ $20.00 each	________
1991 Poster	___@ $25.00 each (limited availability)	________
1992 Poster	___@ $10.00 each	________
1993 Poster	___@ $10.00 each	________
1994 Poster	___@ $10.00 each	________
1995 Poster	___@ $10.00 each	________
1996 Poster	___@ $10.00 each	________
1997 Poster	___@ $10.00 each	________
1998 Poster —Signed limited edition —Numbered prints of original artwork	___@ $10.00 each ____@ $100.00 each (limited availibilty) ____@ $200.00 each (limited availibilty)	________ _________ _________
1999 Poster	___@ $10.00 each	________
2000 Poster	___@ $10.00 each	________
2001 Poster	___@ $10.00 each	________
2002 Poster	___@ $10.00 each	________
2003 Poster	___@ $10.00 each	________
2004 Poster	___@ $15.00 each	________
2005 Poster	___@ $15.00 each	________
2006 Poster	___@ $15.00 each	________
2007 Poster	___@ $15.00 each	________
2008 Poster	___@ $15.00 each	________

Make check payable to: Detroit Institute of Ophthalmology and mail to: EyesOn Design 15415 E. Jefferson Avenue Grosse Pointe Park, Michigan, 48230
Ship poster(s) to:
Name:___________________________________________________________
Address:________________________________________________________
City:________________________	State:____	Zip:_____	Phone:_______