Veterans Donation form

Veterans' Memorial Donation Form

Donor's Name: ____________________________________________

Address: _________________________________________________

City: ____________________ State: ____________ Zip: _________

Phone Number: (____) ________________________

e-Mail Address: ______________________________

I would like _______ bricks at $50.00 each = ___________

Name as it should appear on the brick(s):

__________________________________________________________

Checks payable to: Assumption Veterans' Memorial

Mail to: Assumption High School; 1020 West Central Park Avenue; Davenport, Iowa 52803

Bricks already in place in front of the Veterans' Memorial.