Photo Bar Card Order Form

YES! I would like to order a photo bar card (I am an active member of the WSBA.)

· Order Online, or

· Print this form and send to the WSBA.

Please select one of the following:

Photo submitted electronically	$10.00
Hard-copy photo enclosed	$15.00
If in Washington , add WA state sales tax (8.9%.):
Total:

If submitting an electronic photo, please e-mail to mykeg@wsba.org. We recommend that you e-mail the photo the same day you send this form. If paying by credit card, you may order via the online store or fax this form to 206-727-8319. If submitting a hard-copy photo, be sure to write your name on the back and enclose it with this form. Your photo will be returned to you.

Check enclosed payable to WSBA  Visa  MasterCard

Card No.____________________________________ Exp.Date ___ / ___

Name as it appears on card ____________________________________

Signature ____________________________________

Please send to:
Membership Services, Regulatory Services Division, WSBA
1325 4th Avenue, Suite 600
Seattle, WA 98121-2330

Name______________________________________  WSBA #_______

* Your bar card will be mailed to your WSBA mailing address.

WSBA office use only: 1-40199-180
Date Check # Total $