Name: _______________________________________

Address: __________________________________________
City: ___________________________ State: __________   Zip: ___________

Phone Number: _____________________________

I am enclosing a check    c

 Send to:     The Gilbert Brown Foundation
                    P.O. Box 130
                    Galesville, WI 54630

I would like an autographed photo.
The cost is $20 plus $5 shipping & handling     c

I would to order Gilbert's Autographed Book "A Year of Champions".
The cost is $50          c

Please send me an autographed "The Gravedigger" shirt.
The cost is $20 plus $5 shipping & handling     c

Total: $ __________

Check Enclosed c     I am paying with Visa c     Master Card c
Card Number: ______________________________
Expires: _________________

Thank you For Your Donation To
The Gilbert Brown Foundation