© 2013 Palm Springs Air Museum 745 North Gene Autry Trail Palm Springs, California 92262 Ph: 760-778-6262 Fax: 760-482-1880
Commemorative Bricks Form

  • Name of Contributor*
  • Phone Number*
  • Email Address*
  • Address*
  • Type of Brick*
  • Select choose one of the following:*
  • Select Payment Type*
  • 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:
  • 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
  • Address
  • Comments/Suggestions/ Additional Information
  • Warning: The Security Code is case sensitive

  • Security Code*

     

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