If you would like to request an autographed photo of Speaker Gingrich or you would like the Speaker to sign an item that you have, please print (use the print icon below) and fill out this form and send to:

Gingrich Communications
c/o Signatures
1425 K Street NW Suite 350
Washington, DC 20005

PLEASE send a self-addressed 8 X 10 envelope
with appropriate postage affixed.

If you are sending a book or other item be sure to include self-addressed return packaging with the proper return postage.

Please personalize to ______________________________________________ (name(s))

Please send to:

Name _________________________________________________________

Address _______________________________________________________

Town _____________________________ ST _____ Zip _____________

Phone _________________________________

email __________________________________

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Don't forget to print and enclose this form.

Expect 4-10 week turnaround.