First Name:
Middle Initial:
Last Name:
Donor Number
Phone:
Email Address:
HERO Special Items:	Solo Flite Children's Book: 25 HERO points America's Heroes Book: 25 HERO points Joe Redington Limited Art Print: 75 HERO points
HERO Merchandise:	Travel Mug: 50 HERO points Cap: 75 HERO points T-Shirt (Limited Edition): 75 points Polo Shirt: 100 HERO points Fleece Throw Blanket: 125 HERO points Fleece Vest: 150 HERO points Sweatshirt (Limited Edition): 200 points Hoody Sweatshirt (Limited Edition): 250 points Fleece Jacket: 300 points
SIZE (if applicable): Shirt or Vest	NA Small Medium Large XL 2XL 3XL 4XL
Total HERO points redeemed for this order:
I would like to PICK-UP my HERO order at the following center:	Anchorage Main Center South Anchorage (Dimond Mall) Center Fairbanks Center
It will be difficult for me to pick-up my order at one of your centers. Please mail it to this address:
Comments / Questions

Providing your contact information on the Blood Bank of Alaska web site implies your consent that we can use the contact information you provide in order to get in touch with you via e-mail or telephone.