Brick Memorial Form

Brick Pathway of Faith

To participate in this 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 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