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
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□ 8” x 8” Standard Size: $150.00
Max. 21 spaces, 5 lines
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□ 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.