Shirt Orders ALL the VMH shirt options are again available to all staff. Attached you will see a four page order form that details each option. Please go to our Intranet site and match the number on the order form to the number on the site to find pictures of each option. Colors, sizes, and prices are all included on the order form attached. Below are the 18 options: #1 Champion Performance Full-Zip Sweatshirt #2 Determination Full-Zip Sweatshirt (non-lined) #3 Crew Neck Sweatshirt #4 Hooded Sweatshirt #5 Ladies Jerzees Nublend Cardigan Sweatshirt #6 Ladies Gildan Heavy Blend Sweatpants #7 Men s Gildan Heavy Blend Sweatpants #8 Gildan Brand Long Sleeved T-Shirts #9 Gildan Brand Regular Short Sleeved T-shirts #10 Port Authority Short Sleeved Camp Dress Shirt #11 Port Authority Long Sleeved Poplin Dress Shirt #12 Port Authority Short Sleeved Polo Shirt #13 River s End Long Sleeved Half Zip Sport Shirt #14 Hanes Short Sleeved Cool Dri Sport Shirt #15 Tri Mountain Long Sleeved Polo Shirt #16 White Bear Soft Shell Winter Jacket #17 Port Authority Nootka Hooded Winter Jacket #18 Port Authority Softshell Spring/Fall Jacket *All shirts will have the basic VMH logo and name embroidered or screen printed in the upper corner of the shirt. VMH is paying for these costs. *Since all of these items have been offered before, there will not be any samples available to try. Please ask another staff member how the sizes run or even for theirs to try on if needed. *Be sure to pay close attention to the order form with all of these choices! *Also include your name on your order form and keep all pages stapled together. *All shirt orders are due into Switchboard by October 9!

Payroll Deduction: Yes No (please circle) If payroll deduction, please fill out the form below and return to Switchboard with your order by 3/27/17. Otherwise, please enclose payment with order. ---------------------------------------------------------------------------------------------------------------------- Veterans Memorial Hospital Waukon, Iowa Payroll Deduction Form I agree to have Veterans Memorial Hospital deduct for my VMH items(s) through a payroll deduction. The TOTAL amount is $. The maximum deduction will be $25.00 per paycheck. (Sorry we can t take the entire cost out of one check unless the total is under $25.) The first deduction will be taken out on the paycheck dated November 3, 2017, and will continue until the total amount is reached. Shirts will not be distributed until this amount is paid in full. Employee's Signature Date Witness Date This form must be signed, witnessed and returned to Switchboard with your order no later than October 9, 2017.

ORDER FORM Name: Department: #1 Champion Performance Full-Zip Sweatshirt (fleece lined) LADIES S260 MENS S270 Black/Black; Athletic Royal/Black; Navy/Stone Gray; Red/Black; Stone Gray/Black; Slate Grey/Black Sizes: S, M, L, XL, 2XL (for both men and women) Cost: Ladies $35.00 each Men s $37 each #2 Determination Full-Zip Sweatshirt (non-lined) LADIES 229342 MENS 229142 Black/Black; Black/Orange; Black/Red; Black/White; Brown/White; Green/White; Graphite/White; Maroon/White; Navy/Navy; Navy/White; Royal/White; Scarlet/White Sizes: XS, S, M, L, XL, 2XL S, M, L, XL, 2XL, 3XL Cost: $29 each (2X add $2, 3X add $3) #3 Crew Neck Sweatshirt White, Black, Antique Cherry Red, Antique Sapphire, Ash, Cardinal Red, Carolina Blue, Charcoal, Indigo Blue, Irish Green, Kiwi, Light Blue, Maroon, Military Green, Gold, Lt. Pink, Orange, Safety Orange, Sand, Sport Grey, Cherry Red, Dark Heather, Forest Green, Garnet, Heliconia, Dark Chocolate, Navy, Purple, Red, Royal, Safety Pink, Sapphire and Safety Green. Sizes: S-5XL Cost: $11 each (2XL add $2, 3XL add $3, 4XL add $4, 5XL add $5) 3. 4. #4 Hooded Sweatshirts : Gildan Heavy Blend 18500 Antique Cherry Red, Antique Sapphire, Black, Cardinal Red, Carolina Blue, Charcoal, Cherry Red, Dark Chocolate, Dark Heather, Forest Green, Garnet, Gold, Heliconia, Ash, White, Indigo Blue, Irish Green, Kiwi, Light Blue, Light Pink, Maroon, Military Green, Navy, Orange, Purple, Red, Royal, Safety Green, Safety Orange, Safety Pink, Sand. Sizes: S-5XL Cost: $16 each (2XL add $2, 3XL add $3, 4XL add $4, 5XL add $5)

#5 Ladies Jerzees Nublend Cardigan Sweatshirt Ash, Black, Navy 773MPR Sizes: S/ M and L/XL Cost: $24.00 each #6 Ladies Gildan Heavy Blend Open Bottom Sweatpants White, Sport Grey, Azalea Pink, Black, Charcoal, Maroon, Navy Sizes: S, M, L, XL, 2XL 18400FL Cost: $15.00 each (2X add $2) #7 Men s Gildan Heavy Blend Open Bottom Sweatpants Ash, Sport Grey, Black, Charcoal, Dk.Heather, Forest Green, Maroon, Navy, Purple, Red, Royal Sizes: S, M, L, XL, 2XL, 3XL, 4XL, 5XL 18400 Cost: $15 each (2X add $2, 3X add $3, 4X add $4, 5X add $5) #8 Gildan Brand Long Sleeved T-Shirts White, Black, Ash, Cardinal Red, Sport Grey, Carolina Blue, Forest Green, Garnet, Gold, Irish Green, Navy, Purple, Red, Royal (Ladies also in Heliconia )(Men s also in Graphite Heather) Sizes: S, M, L, XL, 2XL, and 3XL. 5400 L 5400 Cost: $10.00 each (2X add $2, 3X add $3) #9 Gildan Brand Heavy Cotton Short Sleeved T-Shirts 5000 White, Black, Antique Cherry Red, Antique Irish Green, Antique Jade Dome, Antique Orange, Antique Sapphire, Ash, Azalea, Berry, Blackberry, Brown Savana, Cardinal, Carolina Blue, Charcoal, Cobalt, Coral Silk, Cornsilk, Daisy, Chocolate, Dark Heather, Electric Green, Forest Green, Garnet, Gold, Graphite Heather, Gravel, Heather Military Green, Heather Red, Heather Sapphire, Heliconia, Ice Grey, Indigo Blue, Irish Green, Kiwi, Light Blue, Light Pink, Lilac, Lime, Maroon, Midnight, Military Green, Mint Green, Natural, Navy, Neon Blue, Neon Green, Old Gold, Orange, Purple, Red, Royal Blue, Russet, Safety Orange, Safety Green, Safety Pink, Sand, Sapphire, Sky Blue, Sport Grey, Sunset Orange, Tennessee Orange, Texas Orange, Tropical Blue, Turf Green, Tweed, Violet & Yellow Haze. Sizes: S, M, L, XL, 2XL, and 3XL. Cost: $6.00 each (2X add $2, 3X add $3)

#10 Port Authority Easy Care Short Sleeved Camp Dress Shirts Ivory, Celery, Blue, Black L535 S535 Sizes: Women: XS, S, M, L, XL, 2XL, 3XL, 4XL Men: XS, S, M, L, XL, 2XL, 3XL, 4XL Cost: $200 each (2X add $2, 3X add $3, 4XL add $4) #11 Port Authority Long Sleeved Stretch Poplin Dress Shirt LADIES L646 MENS S646 Black, Blue, Grey, Purple, Black, Grey Smoke, Moonlight Blue, White, Wintergreen White, Wintergreen, Pink & Teal Sizes: XS, S, M, L, XL, 2XL, 3XL, 4XL XS, S, M, L, XL, 2XL, 3XL, 4XL Cost: $24.00 each (2XL add $2, 3XL add $3, 4XL add $4) #12 Port Authority Short Sleeved Polo Shirt LADIES L555 MENS K555 Blue, Wintergreen, White, Navy, Grey, Purple, Red, Black & Pink(Women s only) Sizes: XS, S, M, L, XL, 2XL, 3XL, 4XL (for men and women) Cost: $16.00 each (2X add $2, 3X add $3, 4XL add $4) #13 River s End Long Sleeved Half Zip Sport Shirt Black, Charcoal, Lime Green, Navy, Red, Blue, White, Orange. (Also Berry in Women s) Sizes: S, M, L, XL, 2XL 1611 S, M, L, XL, 2XL, 3XL 1610 Cost: $25 (2X add $2, 3X add $3) #14 Hanes Short Sleeved Cool Dri Sport Shirt 31800 Women s: Black, Red, Navy, Royal, Graphite, White, Pink 4800 Men s: Black, Red, Navy, Royal, Graphite, White Sizes: Women: S, M, L, XL, 2XL Men: S, M, L, XL, 2XL, 3XL Cost: $18.00 each (2X add $2, 3X add $3)

#15 Tri Mountain Long Sleeved Polo Shirts Black, Maroon, Forest Green, Dark Grey, Royal, Jade, Khaki, Maroon, Navy, Purple, Red, Slate Blue, Light Yellow and White. Cost: $29.00 (2X add $2, 3X add $3) 602 608 Sizes: XS, S, M, L, XL, 2XL, 3XL and 4XL. Men s Extended Sizes 5XL, 6XL, XLT, 2XLT, 3XLT, 4XLT, 5XLT and 6XLT available in these colors only: Black, Forest Green, Heather Grey, Royal, Khaki, Maroon, Navy, Red and White. #16 White Bear Soft Shell Winter Jacket 100% Polyester Shell, bonded with Micro Fleece inside for water and wind resistance. LADIES MENS Black, Navy and Charcoal Black, Navy, Charcoal and Royal Sizes: XS, S, M, L, XL, 2XL S, M, L, XL, 2XL, 3XL, 4XL, 5XL, 6XL, LT, XLT, 2XLT, 3XLT, 4XLT, 5XLT, 6XLT Cost: $65.00 each $65.00 each Men s or Women s: Name On Jacket: #17 Port Authority Nootka Hooded Winter Jacket 100% rip stop nylon shell, windproof and insulated with superior waterproof protection. LADIES L792 MENS J792 Black, Graphite, Blue, Red, Orange, or Green Sizes: XS, S, M, L, XL, 2XL, 3XL, 4XL XS, S, M, L, XL, 2XL, 3XL, 4XL Cost: $60.00 each $60.00 each (2X add $2, 3X add $4, 4X add $6) Men s or Women s: Name On Jacket: #18 Port Authority Vertical Softshell Spring/Fall Jacket 100% Polyester knit with a sporty look, water resistant. LADIES L319 MENS J319 Black, Cyan Blue, Magnet Grey, Black, Green Grass, Magnet Grey, Red, &Snorkel Blue Red, Snorkel Blue Sizes: XS, S, M, L, XL, 2XL, 3XL, 4XL (for both men and women) Cost: $46.00 each Men s or Women s: Name On Jacket: