Show Your Support For 
THE  MOTORCYCLIST MEMORIAL

Have your name , your family, your business, or other personal statement placed on the 
“walk of memories” leading to the Memorial Wall. These high quality brick pavers come in two sizes. 4x8  (3 lines $50)  and  8x8 (6 lines or 3 lines and a symbol $75). Please add $10 for flag symbol.  (symbols below) 


Brick Lettering  of no more than 14 letters per line
including spaces and punctuation 

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


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


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


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


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


SYMBOL_________

(see below)





PLEASE PROVIDE THE FOLLOWING INFORMATION:


YOUR NAME_________________________________________________________________________

STREET       _________________________________________________________________________

CITY             __________________________________ STATE ______ ZIP CODE ________________   

PHONE               (          ) ___________________________

EMAIL          _________________________________________________________________________

PLEASE MAKE CHECK OR MONEY ORDERS PAYABLE TO :

THE MOTORCYCLIST MEMORIAL FOUNDATION
P O  BOX 2573
Wintersville , Ohio 43953

ANY QUESTIONS OR CONCERNS CALL:
Rick Lister 406-498-8568




DEADLINE FOR APPLICATIONS ARE 6 WEEKS PRIOR TO MEMORIAL DAY
AND 6 WEEKS PRIOR TO LABOR DAY 
BRICKS ARE ENGRAVED ONLY TWICE YEARLY AND ARE SUBJECT TO BOARD APPROVAL

SOME SYMBOLS NOT SEEN MAY BE SPECIAL ORDERED
CALL RICK FOR MORE INFORMATION



A - Heart
 
B - Motorcycle
 
C - Crucifix
D - Dove
 
E - Eagle
 
F - Flag