These badges are available for order by teachers only

Application Form for Performance Badges for Speech & Drama & Public Speaking candidates

Name of teacher: ………………………………………………………………………………………

Address: ………………………………………………………………………………………………...

Phone No:…..………………………………………………

E-mail address: ……………………………………………

Badges are available in packs of 5  and 10.  Please indicate how many packs of each grade you require.

Initial Grade: ............... packs containing ………….badges

Grade One: ................. packs containing ………. ...badges

Grade Two: ................ packs containing …………...badges

Grade Three: ............. packs containing ………..….badges

Grade Four: ............... packs containing …………...badges

Grade Five: ............... packs containing …………....badges

Grade Six: ................. packs containing ………........badges

          Grade Seven:..…..…....packs containing ……......…..badges

          Grade Eight:................packs containing …………....badges

Badges cost $35.00 per pack of 5 and $70.00 per pack of 10 plus $3.00 postage & packaging.  Money must accompany the order.  The badges will be sent to you by courier as soon as possible after order is received.

Enclosed is $...................... in payment for the above.

Please print this form, fill in and send to: Speech New Zealand, P O Box 12-023, Wellington

For office use only:

Date order received _____________Date order despatched______________

By:______________________