Our next dedication is planned for August 1st

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BRICK ORDER FORM

First Name

Last Name

Street Address

City

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State

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Zip Code

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Emaila valid email

Phone Number

Are you a current member?

YesNo

FILL OUT SEPARATE ENTRY BELOW FOR EACH BRICK PURCHASED - UP TO 3 LINES PER BRICK - UP TO 20 CHARACTERS PER LINE (includes spacing and punctuation) SEE ABOVE EXAMPLE. Please Note that if you only chose 1 or 2 lines, they will be centered on the brick.

LINE 1 of FIRST BRICKUP TO 20 CHARACTERS PER LINE

LINE 2 of FIRST BRICKUP TO 20 CHARACTERS PER LINE

LINE 3 of FIRST BRICKUP TO 20 CHARACTERS PER LINE

LINE 1 of SECOND BRICK (if buying 2 Bricks)UP TO 20 CHARACTERS PER LINE

LINE 2 of SECOND BRICK (if buying 2 Bricks)UP TO 20 CHARACTERS PER LINE

LINE 3 of SECOND BRICK (if buying 2 Bricks)UP TO 20 CHARACTERS PER LINE

Item	Qty	Total
Bricks	1	[field9]

You should receive an email notification once your form submission is successful. Please email info@wgart.org if you did not receive that email after your order.more details

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