MMF

MEMORIAL WALL

NAME ENGRAVING APPLICATION

THE FOLLOWING INFORMATION IS NEEDED TO HAVE A

NAME ENGRAVED  ON THE MEMORIAL MONUMENT

THE CHARGE FOR ENGRAVING A NAME IS $150 PER NAME

NOTE: MAXIMUM OF 25 LETTERS INCLUDING PUNCTUATION MARKS OR BLANK SPACES

ANY QUESTIONS PLEASE CALL:

Justin Groch (740-) 278-2470

or

Brian Straka (740) 765-5147

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _*

NAME 25 CHARACTERS MAX

BIRTH YEAR_ _ _ _   *    DECEASED   _ _ _ _ *

PLEASE GIVE THE FOLLOWING INFORMATION

YOUR NAME _________________________________________________

STREET        _________________________________________________

CITY              __________________________________  STATE __________ ZIP CODE ____________

PHONE         (        )______________________

EMAIL           _________________________________________________

PLEASE MAKE CHECK OR MONEY ORDERS PAYABLE FOR $150 TO

THE MOTORCYCLIST MEMORIAL FOUNDATION

PLEASE MAIL WITH YOUR CHECK OR MONEY ORDER TO:

THE MOTORCYCLIST MEMORIAL FOUNDATION

P.O.  BOX 2573

Wintersville, Ohio 43953

                             * PLEASE CHECK SPELLING AND DATES,

                                          ALL ENGRAVINGS ARE FINAL*

       DEADLINE FOR APPLICATIONS ARE 6 WEEKS PRIOR TO MEMORIAL DAY                                                       AND 6 WEEKS PRIOR TO LABOR DAY

                               ENGRAVINGS ARE DONE ONLY TWICE YEARLY