Commemorative Brick Order Form

Yes, I/We want to reserve a permanent engraved brick to be installed at the new Early Childhood Center at The Pennsylvania School for the Deaf (PSD).  (If ordering more than one brick, please fill out a set of blocks for each brick.)  PLEASE PRINT.  If you need more forms, please contact rcella@psd.org.

Name:  ________________________________________________________________________

Address: ______________________________________________________________________

City/State/Zip: _________________________________________________________________

Phone: _______________________ Email: ____________________________

Bricks are 4"x 8".  Each brick may contain up to 3 lines of print, 13 characters per line (includes letters, spaces and numbers used). Bricks may also have just one or two lines of print.  PLEASE PRINT your inscription in the spaces provided, being certain to leave blank spaces between words and designate commas and periods.  All names will be centered on the bricks at the time of engraving. SAMPLES

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BRICK 1