We are raising money to help pay for a brick walkway and garden to the left of the
Lamprey House Museum. Bricks will also be placed on both the front main walkway
and side entrance of the Lamprey House.
We will be using red 4 X 8 bricks. The Donation price is $75.00 per brick.
You can also order a brick for yourself for only $30.00 more.
Would you like to receive Donor Certificate - $12.00
(We recommend that you use all caps which make the bricks easier to read)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Yes, we’d like to reserve a permanent brick. Please engrave our brick as follows:
ANY SYMBOL IS CONSIDERED ONE SPACE (PERIOD, COMMA, DASH)
ALL TEXT IS CENTERED UNLESS OTHERWISE NOTED
4 x 8 Brick
EXAMPLE
M O
U
L
T
O
H
I
S
T
O R
2
0
1
3
N
B
O
R
I
C
A
L
O
U G
H
S
C
O
I
E
T
Y
PLEASE RETURN THIS FORM AND YOUR CHECK PAYABLE TO:
Moultonborough Historical Society
P. O. Box 659
Moultonborough, NH 03254
Name: ________________________________________ Phone: (_______) _________________________
Address: _______________________________________________________________________________
City: ____________________________________ State: __________________ Zip: __________________
Email Address: ___________________________________________ Amount Paid: ___________________
FORMS MUST BE RECEIVED BY JANUARY 1, 2014.
If you have any questions, please call Norman Atkinson at (603) 998-3455.
YOU CAN ALSO ORDER ON OUR ON-LINE ORDERING WEBSITE:
WWW.BRICKSRUS.COM/ORDER/NAMEOFORGANIZATION