Lithophanes Book Order Form

Name___________________________________

Email address____________________________

Address_________________________________

City_____________State_____Zip Code_______

Phone number____________________________

Member? (circle one) YES NO

Number of copies

____ Member ($50.00 per book) $_______

____ Nonmember ($59.95 per book) $_______

Shipping within USA only($5.00 per book) $_______

Total Enclosed $_______

Payment in U.S. Dollars only.

Make check or money order payable to Blair Museum of Lithophanes and mail to:

The Blair Museum of Lithophanes

Book Department

5403 Elmer Drive

Toledo, OH 43615