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

State

Zip Code

Brick Inscription

Each brick may contain up to three lines. Up to 14 characters, including spaces and punctuation, are permitted on each line.

Inscription on Brick:

Additional information or inquiry

Total

$ 0.00

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*If you wish to pay by credit card, please make sure you are not logged into PayPal.