YES! Engrave my name into Darien History with a personalized Darien Lions Club Pavilion Patio Brick!

 

 

Purchaser’s Name

 

Street Address

 

City                          State                           Zip

 

Phone (Home)

 

Phone (Business)

 

To order your brick(s) today, fill out and detach the order form and mail it with your payment to:

 

Darien Lions Club Foundation
Recognition Brick Patio Program

1702 Plainfield Road

Darien, IL  60561

 

 Include Check or Money Order payable to:
    Darien Lions Club Foundation
.
 
    (Please do not send cash)


 

Signature


Under Internal Revenue Service guidelines, the full amount of your payment is a deductible contribution.  You will be receiving an additional letter of thanks from the Darien Lions Club Foundation, which is a 501 (c) (3) fully accredited foundation. This should serve as documentation of your gift.

 

Simply check off the size of brick(s) you are ordering, and print the information exactly as you would like it to appear.  Spaces and punctuation marks count as characters.

Corporate Logos and crests are not
 available on 4” x 8” bricks.

 

  4” x 8” Standard Size:  $100.00

     Max. 21 spaces, 3 lines

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  8” x 8” Standard Size:  $150.00

     Max. 21 spaces, 5 lines

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Check here if a corporate logo or family crest is requested.   (You will be notified of any additional costs required to create the logo.) 

Thank you for your donation!

 

Instuctions:  
 * Use your browser to print this form.
 * Fill in all required information.
 * Include your payment
 * Mail to the Darien Lions Club Foundation address.