Camp Moore Memorial Brick Program
Order Form
1.
We are now ordering bricks in January, April and September. You will be notified via the Friends of Camp Moore
Newsletter as to the actual installation date for orders placed.
2.
You will receive a certificate documenting your memorial brick in honor of the
person/organization that you have chosen.
3. Four
lines with up to 15 spaces per line - SPACES HAVE TO BE LEFT BETWEEN WORDS! Punctuation counts as a space.
PLEASE PRINT
Customer
Name__________________________________________________________
Address_____________________________________
City________________________
State_________ Zip____________
MasterCard or Visa__________________ Card No.______________________________
Expiration Date____________
Signature____________________________________
Enclosed is your check, money order or credit card order for $50.00 for each brick ordered
REMEMBER TO INCLUDE SPACES BETWEEN WORDS!!!
Return to Memorial Brick Program Page
©2007 Camp Moore Historical Association
In memory of my beloved Christin