Please fill out and print this form and include it with your check or money order made payable to:

Doria Roberts
P.O. Box 5313
Atlanta, GA 31107

For more info, contact info@doriaroberts.com

ITEM	QUANTITY	TOTAL
"Alive & Well" ($20 each)		$
"Restoration" ($15 each)		$
"Queerstock CD" (double disk) ($15 each)		$
SHIPPING Please add $5 for shipping outside the US		$
TOTAL		$

Name
Email
Phone
Shipping Address Please include city, state and zip
Comments
Check here to be added to the Doria Roberts Mailing list. Check here if you want your cd signed.