Brick Order - Friends of Hyder Family Hospice House

A Memorial Brick costs $50. All project profits help to support Friends of Hyder Family Hospice House.
Please fill out and submit the form below.
After you submit the form, you will be able to pay by PayPal or credit card*.

How many bricks would you like to order? *

1 Memorial Brick - $ 50.00
2 Memorial Bricks - $ 100.00
3 Memorial Bricks - $ 150.00

Name of Honoree, if applicable.

If the brick is in honor of someone, please indicate his or her name in the box above. This is for our records. The name doesn't necessarily appear on the brick, unless requested on the inscription below.

Name *

First

Last

Email *

Phone

Address *

Address Line 1

Address Line 2

City