NLC Item Request Form Did you not receive an item at the National Leadership Conference? Please fill out the form below: Confirmation Number Requests are due no later than August 1, 2019. To order duplicate plaques or replace a lost/damaged plaque, please contact Brett Paxton with Graphic Awards at 800-365-4998.Name* First Last Email Address* Phone*Shipping Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Item(s) Requested* Plaque ($8.00 Shipping) Medal ($7.00 Shipping) Ambassador or other pin ($4.00 Shipping) NLC T-Shirt ($8.00 Shipping) Honor Cord or Tassle ($7.00 Shipping) OtherParticipant(s) Name, Competitive Event Name, and Rank (for plaques and medals)T-Shirt Size (if applicable)SMLXLXXLXXXLXXXXLPayment TypeCredit Card (we will contact you directly for payment)Check (Items will be shipped once the check is received)Internal Notes This iframe contains the logic required to handle Ajax powered Gravity Forms. Need to talk to us?Our staff is here to help you and answer any questions you may have. Use our form to send us a quick message and someone will get back to you shortly. What can we help you with today?*Select from listGeneral InformationNLC SupportDonationsMembershipBPA CaresVolunteerTechnical SupportFinancial InquiriesYour NameEmail Address* Untitled*CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.