(Check Payable to Darlington Veterans Memorial)
BRANCH OF SERVICE
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DATES SERVED OR THEATER SERVED IN
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RANK/RATE
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NAME
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Please Print Clearly Up to 17 total letters and spaces per line - no exceptions
 Please send me a receipt for my records.
Darlington Veterans Memorial Brick/Donation Order Form
Contact Person
Address/City/State/ZIP
Phone #
Email
Comments
This person has an honorable discharge  Yes  No Date
Veterans Memorial Brick:
 $50.00
Brick(s) and
Additional Identical Keepsake Brick:  $50.00
Donation Total:
Additional Tax-Deductible Donation:  ______
$
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“Honoring the men and women who
faithfully served our nation and
preserved our freedom and liberty.”
Darlington Town Square
PO Box 62
Darlington, South Carolina 29540
darlingtonveteransmemorial.com
Darlington
Veterans Memorial
The Darlington Veterans Memorial
is financed by selling bricks and
generous donations of any amount.
Location:
The cost of each brick is $50. An
identical keepsake brick is an
additional $50.
Anyone may purchase a brick for
themselves or loved ones whether
living or deceased. The Veteran on
the brick must be honorably
discharged.
Forms can be mailed to:
Darlington Veterans Memorial
PO Box 62
Darlington, SC 29540
Make checks payable to Darlington
Veterans Memorial.
Forms as well as Purchases and
Donations can be completed
securely online through PayPal on
our website:
darlingtonveteransmemorial.com
Brick Purchases and Donations are
tax-deductible and receipts will be
mailed upon request.
Online Brick Purchases/Donations
will be emailed a receipt.
Darlington Veterans
Memorial Committee
Jane Lloyd, Chair
Tonda Weaver, Treasurer
David Vaughn, DDRA Treasurer
Mike Beckham, Secretary
Bert Lynn, Landscape Architect
Bert Sandifer, Web and Graphics
Danny Weaver
Jimmy Williams
John Segars
Bill Abbott
Bobby Kilgo
Tony Watkins
Dr. David Eads
Steve Crosby
John Odom
James Marsh
Jonathan Weaver Rocky Gannon
For More Information Contact:
Jane Lloyd at 843-245-6333 or
email at [email protected].
Visit our website for news/events at
darlingtonveteransmemorial.com
The Darlington Veterans Memorial
will be located at the corner of Main
Street and Orange Street in the Town
Square. The prominent location of the
Memorial will be a place of reflection
as our community remembers those
soldiers who faithfully served in the
United States of America Military.
Sample Brick: