CARNYCON LIVE DVD ORDER FORM Please mail completed form with payment to: Beth Blighton PO Box 8655 Benton Harbor, MI 49023 Full Name: _____________________________________________________________________________ Contact E-mail: _________________________________________________________________________ Street Address: ________________________________________________________________________   City: _________________________________  State/Providence: _______  Zip/Postal: ____________ Country: ___________________________________ Contact Phone Number: _________________________________________________________________ Number of DVD sets:  ________ @ $49.95 plus $6.50 shipping and handling per set (Please add an additional $1.50 per set if ordering more than one.)   Total enclosed: $ ________________ Please select one: [   ] Check or Money Order Enclosed (made payable to: The Clancy Brown Fan Club )     [   ] Paid online with PayPal:  Email used: ____________________________________ Thank you for your order!