Brick Memorial Form

Brick Memorial Foundation and Brick Pathway of Faith

To participate in either program, please fill out the form below.

• Fill in all requested contact information.
• Make your tax-deductible contribution check payable to:  The Holden Beach Chapel
• Send check and order form to:    

Holden Beach Chapel

c/o HB Chapel Brick Foundation

107 Rothschild Ave.

Holden Beach, NC 28462

 

 

_______      I would like a Memorial/Honor Foundation Brick ($1000 minimum Contribution).

*20 Characters per line including spaces (2 Lines)

Please print name and information you would like on your Memorial/Foundation brick below.           

1.  __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __   

 

2.  __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __      

                          

 

 

______I would like a Pathway of Faith brick ($500 minimum contribution)

*20 Characters per line including spaces (3 lines)

Please print name and information you would like on your Pathway of Faith brick below.                   

1.  __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 
    

2. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 

 

3.  __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 

Please fill out the following information completely so we can contact you if we need clarification on the engraving message.

 

Name:       ______________________________________________________________

 

Address:   ______________________________________________________________

 

City           ___________________________     ST.______________   Zip_____________

 

Email:       ______________________________@ ________________________________

 

One brick per form. You may copy this form for multiple orders or contact us at secretary@atmc.net