Debi Derryberry : Autograph

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To receive an autographed headshot, please complete the following form.

(Autographs are $6.00 for US shipping or $8.00 for International shipping)

*First Name:
*Last Name:
*Address:
*City:
State:
*Zip:
Email:
*How many autographed headshots would you like?
How would you like your autograph(s) personalized?
*Choose payment method:	I will pay the handling and shipping fee with PayPal once I have submitted this form. I will send the appropriate shipping and handling fee with a Self Addressed Stamped Envelope.

Name
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Kids’ Names

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