(sample plaque)
(PRINT THIS FORM, OR DOWNLOAD THE FORM BELOW AND MAIL)
Double T Association
Box 6785
Lubbock, TX 79493-6785
e-mail: dta@ttu.edu
(The plaque will hang in the Double T Lounge at Texas Tech)
Cost of Plaque: $500.00
A 5X7 BLACK AND WHITE OR COLOR PHOTO WILL BE NEEDED TO COMPLETE ORDER REQUIREMENTS.
Name: _____________________________________________________________
Address: ___________________________________________________________
City, State, Zip ______________________________________________________
Phone: (home) ____________________________ (work) ______________________
E-mail: _____________________________________________________________
Is the plaque a gift for a letter winner? _______________________________________
Will this plaque be dedicated as: “In Memory of ______________________________?”
PLAQUE INFORMATION
NAME: ___________________________________________________
As you want on the plaque. You may include a nickname.
SPORT: __________________________________
YEAR: ___________________________________
SPORT: __________________________________
YEAR: __________________________________
SPORT: __________________________________
YEAR: __________________________________
Payment: $500.00 (cash) ______ (check) _____
Pay out pledge:
5 years - $100.00 per year ___________
(Plaque may be paid off at any time.)
Made check to Double T Association
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