Brick Form

Any veteran is eligible to obtain a brick. A donation of $30.00 will ensure a lasting memory for yourself
or a Veteran of your choosing. If you choose more than one brick and would like them placed together
we ask that you purchase them together and indicate that they are a set of bricks. Once a brick is placed
it cannot be moved.

                                                                   Bob Gill
                                                      Freedom Hill Brick Chairman
                                                              (585-425-0599)

                Please Make Checks Payable To:

                   VFW Post 8495

P.O. Box 92

                     Fairport, New York, 14450

Each brick can accommodate a maximum of 3 lines with 20 letters or numbers per line, including spaces. Example:

                      Sgt. Robert A. Jones
                       5th Special Forces
   Vietnam 1967-68

Print this page and fill in the three lines below and send for your brick along with your donation.
Please Print:
Line 1 _______________________________________________________________

Line 2 _______________________________________________________________

Line 3 _______________________________________________________________

(Please include your telephone number)

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