CHAPTER SUPPLY ORDER FORM - Illinois, St. Charles & St. Louis

BNI Mid America Region

Medici MediaSpace, 2055 Walton Rd, Overland, MO 63114

Date Order Prepared:	10/17/2018
Your Name:
Phone:
*Chapter:
# Members:	# Referrals/Mo.
	We will pick up supplies at our area RSS (no shipping fee) Please ship our supplies ($20 shipping fee)
*All these fields are required:
*Ship To:
Company:
*Address:
*City/State/Zip:	//
*Email:

NOTE: A $20 fee for processing and shipping will be added at checkout.  Please allow 1 week for delivery.
Questions? Email nicolem@bnimidamerica.com or call: 314-822-1030 x0.

CHAPTER SUPPLIES (BOLD = supplies need most)

Item	QTY	# Ordering
Visitor Packets (includes: new member application, visitor information sheet, regional production number, member testimonials and a marketing brochure)	10
Visitor Name Tags	25
Referral Slips (per pack)	250
Green "I Have" Report Cards (per pack)	100
Notable Network Certificates	10
New Member Applications	10
Renewal Applications	10
Post Card Invitations	25
BNI Director Business Cards	25
Ribbon - Education Coordinator	1
Ribbon - Events Coordinator	1
Ribbon - Growth Coordinator	1
Ribbon - Membership Committee	1
Ribbon - Mentor	1
Ribbon - Mentor Coordinator	1
Ribbon - Power Teams Coordinator	1
Ribbon - President	1
Ribbon - Secretary Treasurer	1
Ribbon - Vice President	1
Ribbon - Visitor Host	1
Ribbon - Webmaster	1
BNI Blue Badge (Director will present to member)	Each
BNI Gold Club Badge and Card Holder (email Gold Club form to BNI Mid America office)	Each
New Member Success Kits (keep 2 on hand)	Each
# of new members that do not have new member kit	Each

NOTE: PLEASE DO NOT BREAK UP NEW MEMBER SUCCESS KITS TO REPLACE MEMBER BADGES OR BUSINESS CARD HOLDERS.
New Member Success Kits are to be given to new members only - the cost is covered by the application fee.
If you need additional kits for an existing member, please order below.

Note any special instructions:

BNI GIFT SHOP ITEMS

Item	Price	# Ordering	Amount Due
BNI Name Badge (Magnetic)	$5.00
BNI Neck Cord (badge holder / lanyard)	$5.00
BNI Card Holder - Small	$8.00
Timer Paddle Set	$25.00
Visitor Welcome Board**	$55.00
Chapter Goal Board**	$65.00
Book - The 29% Solution	$10.00
Book - Money on the Table	$17.00
Book - Room Full of Referrals	$17.00
Book - Avoiding The Networking Disconnect	$17.00
Book - Who's In Your Room?	$17.00
Library Starter Pack	$230.00
Additional Member Success Kits	$25.00
Passport To Success	$2.00

Shipping      $

TOTAL DUE      $

**An additional $20 shipping charge will be added for each oversized item.