Remembrance Brick Form


Alumni Remembrance Brick Return Form

 

NAME (engraved) _______________________________________

GRADUATING CLASS (optional) ___________________________

ADDRESS _______________________________________________

CITY __________________________________________________

STATE _________________________________________________

ZIP CODE ______________________________________________

PHONE NUMBER __________________________________________

 

Return with a $40 check payable to:

Williamsville South Courtyard Project
Attention: Principal
5950 Main Street
Williamsville, NY 14221