Veterans Brick Walkway – PHASE II
Pearl River County Courthouse, Poplarville
Coordinated by Poplarville Rotary Club and Poplarville Chamber of Commerce
Special Thanks to: Pearl River County Board of Supervisors, Pearl River Community College, ReSteel Express, and Huey Stockstill, Inc.
Instructions for completing your order:
1. All letters must be capitalized. (Ex: JOHN SMITH)
2. Print neatly and legibly as we will not be responsible for illegible letters or incorrect spelling.
Bricks will be engraved according to information supplied. Please do not add blocks or alter
order form. We reserve the right to make changes to fit engraving guidelines.
3. Use a black or blue pen.
4. One name per brick. Separate order forms for each Veteran is required.
5. Complete order form and include your check for $50.00 made payable to the Poplarville Rotary
Club. Completed order form and check should be mailed to Veterans Brick Walkway Memorial, c/o
Mississippi Power Company, 201 West Cumberland Street, Poplarville, MS 39470.
Must leave one space between first and last names
Engraving Suggestions: Veterans Name*Rank*Branch*War or Date of Service (WWII, Vietnam, etc.)*Awards/Decorations*
WIA (if wounded), KIA (if killed in action) POW (if prisoner) Date examples: Jan 88-Dec 99 or 01/88 – 12/99 – NOTE:
We reserve the right to make changes to fit engraving guidelines.
Name of person ordering brick:
Street Address:
City:
State:
Zip:
Telephone Number:
Email:
Example of Brick:
J
J
A
O
N
H
N
‘
C
H
8
8
S
M
I
P
‘
-
D
E
I
C
T
H
9
9