Commemorative Brick

Order Form

Name: _____________________________

Address: ___________________________

City: _____________State: ___ Zip: _____

Phone: ____________________________

Print 4” x 8” Brick Text; $100/brick, 3 for $250

Print 8” x 8” Brick Text; $200.00 per Brick

If you are ordering more than one 4” x 8” brick, you may use another order form or insert
text for 2^nd or 3^rd brick in above area. Please specify number and size of brick being ordered.

4” x 8” quantity ___ 8” x 8” quantity ___

Make checks payable to: NHPF. Mail this order form with payment to:

Commemorative Brick Program

National Horseshoe Pitchers Foundation

P.O. Box 1628

Penn Valley, CA 95946

Questions? Phone NHPF at 530-432-2192