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Every Brick Matters

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Engraving includes up to 3 Lines, 16 maximum characters per line, including spaces

Namerequired
First Name
Maiden (optional)
Last Name
Would you like your name to be published in the Report to Donors?required
ex. Smith Family, preferred first name
Perkiomen AffiliationrequiredSelect all that apply
Select all that apply
Donation for Brick 1required
Please enter a price greater than or equal to $101.00
Maximum 16 characters. If in memory of someone, note here.
Maximum 16 characters
Maximum 16 characters
Donation for Brick 2required
Please enter a price greater than or equal to $101.00
Maximum 16 characters. If in memory of someone, note here.
Maximum 16 characters
Maximum 16 characters
Donation for Brick 3required
Please enter a price greater than or equal to $101.00
Maximum 16 characters. If in memory of someone, note here.
Maximum 16 characters
Maximum 16 characters
Donation for Brick 4required
Please enter a price greater than or equal to $101.00
Maximum 16 characters. If in memory of someone, note here.
Maximum 16 characters
Maximum 16 characters
Donation for Brick 5required
Please enter a price greater than or equal to $101.00
Maximum 16 characters. If in memory of someone, note here.
Maximum 16 characters
Maximum 16 characters

Payment Information

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