IPMS/USA Community Activities Coordinator
Make 'N Take Materials Request Form

Event Begin Date:

Event End Date:

Date which you need kits to arrive:

Please request models at least 2 weeks (14 calendar days) before your event date to allow sufficient shipping and handling time.

Enter the Number of Kits you wish for each Age Group:

ALL children between the ages of 5-6 need to be accompanied by a Parent.

Ages 7 - 15 Years Old

Aircraft

Cars

Available kits are listed on our Products Page

Event Information

Name:

Website:

(MUST begin with "http://")

Chapter Name:

(Name of Host Chapter)

Location:

(Name of Facility/Building)

Address:

City:

State:

Is this in conjunction with a Contest?

Yes

Contact Information

Name:

Phone:

Address:

City:

State:

Zip:

E-Mail:

Remarks or other additional info:

Submitter Information

Name:

IPMS Number:

Expiration Date:

mm/dd/yyyy

E-Mail:

Please do not click the "Submit" button more than once!