CD Request Form

To order the LIPC winners CD(s) by mail, please fill out and print the form below and send it with your check or money order in the amount of $17.99 per CD (shipping and handling included) to Ms. Pat D'Amico (LIPC's Chair of PR Committee):

Pat D'Amico
250 Vandenburg Dr.
Alexandria, LA 71303

Please allow 2-4 weeks for delivery. If you have any questions, please contact Ms. D'Amico directly by E-mail at info@southernemblem.com.

 

Shipping Address
*Full Name:
*Address Line 1:
Address Line 2:
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Phone:
E-mail:
Dizhou Zhao: Chopin's Complete Etudes		Quantity:
Anna Polusmiak-Shelest: Rachmaninov's Complete Moments musicaux and Etudes-tableaux		Quantity:

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