Show Your Support For

THE  MOTORCYCLIST MEMORIAL

Have your name , your family, your business, or other personal statement placed in the

“walk of memories” walkway leading to the Monument. These high quality brick pavers

are 4x8 inch with three lines of lettering

At a cost of $40.00 per brick

Brick Lettering ( up to 3 lines ) of no more thane 14 letters per line

including spaces and punctuation

____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____ 

UP TO 14 CHARACTERS

____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____

UP TO 14 CHARACTERS

____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____  ____ 

UP TO 14 CHARACTERS

PLEASE GIVE THE FOLLOWING INFORMATION

YOUR NAME_________________________________________________________________________

STREET       _________________________________________________________________________

CITY             __________________________________ STATE ______ ZIP CODE ________________  

PHONE               (          ) ___________________________

EMAIL          _________________________________________________________________________

PLEASE MAKE CHECK OR MONEY ORDERS PAYABLE TO

   THE MOTORCYCLIST MEMORIAL FOUNDATION

                                 MAIL THIS FORM WITH YOUR CHECK OR MONEY ORDER TO :

THE MOTORCYCLIST MEMORIAL FOUNDATION

P O  BOX 11

Richmond , OHIO 43944  

ANY QUESTIONS PLEASE CALL:

Tom (740) 282-3045 or Paul  (740) 282-1835