Hillcourt Scout Museum

BRICK FORM

 

Purchaser’s Name ____________________________________

 

Address ____________________________________________
___________________________________________________

 

Phone Number ______________________________________

 

Each Brick will have an inscription of one to three lines

 (14 characters per line, total 42 characters). Spaces and punctuations count as a character.

Cost of each Brick is $50.00

Make checks payable to: Hiawatha Seaway Council

Mail or drop off completed applications with payment to:

Hiawatha Seaway Council

Brick Walkway Program

2803 Brewerton Road

Syracuse, NY 13211

Note: Your Brick will be ordered only after payment is received.

 

PLEASE PRINT EACH CHARACTER EXACTLY AS YOU WANT IT TO APPEAR ON THE BRICK.

 

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