Shenandoah University
~PURCHASE AN ENGRAVED BRICK~
You can pave the way to the theatre and support the Alumni Scholarship Fund. Your brick(s) will be permanently displayed at the entrance of Ohrstrom-Bryant Theatre and Ruebush Hall.
$75 = engraved brick/$50 = current student, faculty or staff $500 = prominently located marquee brick NAME:____________________________________
ADDRESS:________________________________
CITY:____________________________________
STATE:______________ZIP:_________________
PHONE:(___)______________________________
EMAIL:___________________________________
Mail form with a personal check or money order payable to Shenandoah University. To charge a credit card, enter your card number and expiration date. Sign where indicated.
Charge: Visa/Mastercard/American Express (circle one)               
BRICK ORDER #1
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Expiration Date
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Month
Year
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BRICK ORDER #2 (or Marquee continued)
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Message Selection: The brick can be engraved with two lines up to 15 characters each (including spaces.) Using capital letters, please print the name or message you would like on your brick in the boxes above. If you are purchasing a mar-­
quee brick, you may use up to four lines.
________________________________
Signature as shown on credit card
____ Number of standard bricks ordered
____ Number of marquee bricks ordered
$____ Total amount enclosed
Your personalized brick(s) can be ordered by mail or faxed to We reserve the right to choose type size and arrange words to maintain a balance and improve legibility.
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Check box if you would like to order more than 2 bricks. If necessary, continue your order on the reverse (540) 665-4508. Please allow 8-10 weeks for your order to be processed and the brick to be placed in the ground. Once your brick has been placed, you will receive a follow up letter with its location. Call 1-800-786-4802 with any questions. side of this form.
Shenandoah University is a 501(c)3 nonprofit organization. All gifts are tax deductible to the full extent of the law. Mail order to: Shenandoah University
Office of Alumni Affairs
1460 University Drive
Winchester, VA 22601