South Burlington Veterans Memorial
“Pathway of Honor” Engraved Paver Order Form
Orders are due by 7/15/16, for installation in the fall of 2016.
Thank you for your interest in ordering a personalized engraved paver in support of the South Burlington
Veterans Memorial. Your engraved paver will be placed in the “Pathway of Honor”, which connects the
Pavilion to the Band Shell at Veterans Memorial Park. All proceeds from this campaign will support the
ongoing maintenance of the Memorial.
□ 4”x 8” engraved pavers are $100.00 each
Please complete and mail this entire form to:
South Burlington Recreation & Parks
575 Dorset Street
South Burlington, VT 05403
□ 8”x 8” engraved pavers are $200.00 each
Please make checks payable to:
City of South Burlington, Veterans Memorial Fund
Total $
You may attach additional copies of this order form if you are ordering more than one engraved paver.
Specific questions about your order may be directed to Lisa Levite, 802-343-4306, or [email protected]
PLEASE PRINT CLEARLY
- Thank you!
Your Name: ___________________________________ Day Phone: ____________________
Address: _______________________________________ Evening Phone: _________________
City, State, Zip___________________________________ Email: _________________________
There are 7 Options for purchasing an engraved paver
**Please** circle which option you would like to order
Paver Options (without a logo):
Option #1 – 4”x 8” paver = $100
Option #2 – 4”x 8” paver = $100
1st line of this paver will read
1st line of this paver will read
IN HONOR OF (name goes on line 1 below)
IN HONOR & MEMORY OF (name goes on line 1 below)
Line 1
Please fill out this box for Options #1 or #2 (the name goes on line 1)
Line 2
Please note: Spacing between words, and punctuation, counts as one space. Use only the
spaces provided; there are no additional spaces available. The name of the person must be on
line 1. Please make sure you have circled which option you would like to order.
“Pathway of Honor” Engraved Paver Order Form p.2: Last Name ____________________
Option #3 – 8”x 8” paver = $200
1st line of this paver will read
IN HONOR OF (name goes on line 1 below)
Line 1
Option #4 – 8”x 8” paver = $200
1st line of this paver will read
IN HONOR & MEMORY OF (name goes on line 1 below)
Please fill out this box for Options #3 or #4 (the name goes on line 1)
Line 2
Line 3
Line 4
Line 5
Please note: Spacing between words, and punctuation, counts as one space. Use only the
spaces provided; there are no additional spaces available. The name of the person must be on
line 1. Please make sure you have circled which option you would like to order.
Paver Options (with engraved logo):
Available Logos to choose from for Options #5, 6 & 7:
“Pathway of Honor” Engraved Paver Order Form p.3: Last Name ____________________
Option #5 – 4”x 8” paver = $100
This paver will have an engraved logo on the left side, then
IN HONOR OF (name goes on line 1)
Please fill out this box for Options #5 (the name goes on line 1 below)
Line 1
Indicate Logo # here: __________
Line 2
Please note: Spacing between words, and punctuation, counts as one space. Use only the
spaces provided; there are no additional spaces available. The name of the person must be on
line 1. Please make sure you have circled which option you would like to order.
Option #6 – 8”x 8” paver = $200
Option #7 – 8”x8” paver = $200
This paver will have an engraved logo on the top,
then
IN HONOR OF (name goes on line 1 below)
This paver will have an engraved logo on the top,
then
IN HONOR & MEMORY OF (name goes on line 1 below)
Please fill out the box below for Options #6 or #7 (the name goes on line 1)
Line 1
Line 2
Line 3
Indicate Logo # here: __________
Please note: Spacing between words, and punctuation, counts as one space. Use only the
spaces provided; there are no additional spaces available. The name of the person must be on
line 1. Please make sure you have circled which option you would like to order.