BRICK ORDER FORM

One brick with 3 lines of 15 characters is $50.00

Name:____________________________Phone Number____________

Address:_________________________________________________

Is the person on the brick:(check one) Living_____ Deceased_____

Homebase teacher:___________________ Amount_______

Each brick has three lines of text with a maximum of fifteen characters or spaces per line. In the following spaces, PRINT how you wish your brick to read. We want the bricks to all look similar, so we are limiting the text to name (on the first line), rank and service (on the second line), and dates of service (on the third line). Remember-- count the spaces between words. Each brick will be centered, so begin in the first box of each line.

Return completed form and a check made out to WKMS to either Ms. Shipp or Ms. Main.

The order period will run from October 1 through December 10. We will put the bricks in the garden in the spring and include them as a part of our Memorial Day observance. If you have any questions, contact any of the above listed people at WKMS.

SAMPLE ORDER FORM: