WoH Form

Commemorative Bricks Form

Name of Contributor*

Prefix

First Name

Middle Name

Last Name

Address*

Type of Brick*
Walk of Honor
Distinguished Flying Cross
Select choose one of the following:*
Brick - $200 (4' x 8')
Border Stone - $500 (8' x 8')
Star - $2,500 (16' x 16')
Select Payment Type*
Credit Card
Check
Each brick, Stone or Star has space for 20 characters per line (including spaces)
Bricks: Total of 3 lines of type available
Border Stones or Stars: Total of 6 lines of type available
*
If you indicate one of the following, that constitutes the First Line but does not reduce your allotted 3 or 6 lines:
In Memory of
In Honor of
Line 1:
Line 2:
Line 3:
Line 4:
Line 5:
Line 6:*
DFC recipients should indicate DFC and the year received. Their stones will be BLACK granite. You will need to provide proof of your DFC award. All others will be on GRAY granite and require no military affiliation.

Write the name and address of the person you wish informed of your gift, and an acknowledgment will be sent. Amount of your contribution will not be disclosed.

Name

Prefix

First Name

Middle Name

Last Name

Address