BRICK BY BRICK

The West Medford Community Center is hosting a fundraiser to support the ongoing growth and development of the Center and community at large. We offer you the opportunity to purchase a custom, engraved brick to be placed in a designated area at the center. Your dedication can be for yourself, someone from your family, your business or organization or some combination of all. Each brick costs $100.00 ($200.00 if ordering a double brick.)

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“Yes, we would like to reserve a permanent brick:”

Name:	Phone #:
Address:
e-mail Address:
Amount Paid:

“Please engrave the brick as follows:”

Each single finished red clay brick is 4” x 8”, and can hold a maximum of 21 characters per line – (18 characters is recommended.) You can order a single or double brick.

EACH SYMBOL TAKES UP A SINGLE SPACE (LETTER, PERIOD, COMMA, SPACE, ETC.)

ALL TEXT IS CENTERED UNLESS OTHERWISE NOTED

First Brick:

Second Brick (if ordering two)

Please submit this form along with your payment. Orders must be received by 10/20/2016. We can accept both check and credit card payments. All check should be made out to payable to “West Medford Community Center.” Please contact the Center if you are looking to make a credit card payment.