Name: _______________________________________________________________

Address: _______________________________________________________________

City: State/Country: Zip: _______________________________________________________________

Quantity		Item	Price		Total
		MBSI Golden Anniversary Book	***  10.00
		Members & Museums Directory*	10.00
		Lapel Pin	5.00
		Mailing Seals – 100	5.00
		Mailing Seals – 50	3.00
		Regina Certificate **	5.00
		Magazines (if available)	6.00
		Marvels of Mechanical Music DVD	25.00
		The Music Box Makers, The History of the Music Box in Ste. Croix	***  10.00
		Merchandise Total

Magazine back issues: Volume & Number   *Included in new member packet

      _________________________ ** Serial Number of your Regina:

_________________________     ________________________

_________________________             ***before price indicates is Limited time offer

All prices include domestic postage. Please request shipping quote for orders outside the United States.

MBSI appreciates contributions to its various funds. If you wish further details, please contact an MBSI Officer or Trustee. Donations are tax-deductible.		FUND CONTRIBUTIONS
	Endowment
	General
	Museum
	Publications
	Video Project
	Other
		Donation Total

Enclose check or complete credit card information below:

VISA / MASTERCARD   _____________________________ Expiration Date ______

Phone ____________________ Security Code ____________

(required for credit card orders) (found in the signature line on the back of your card)

Signature _______________________________________________________________

Orders may be mailed to: MBSI               or fax to:   417-886-8839

PO Box 10196                                         Springfield, MO 65808-0196