Raymond Historical Society Commemorative Walkway
Name ____________________________________________________________
City________________________ State _______________________Zip_______
Number of Bricks____________ x $50 Donation = Total $_______________
Up to 3 lines per brick
Up to 14 Characters per line - including spaces and punctuation
Please print clearly in all capital letters
Make your check payable to: Raymond Historical Society
Send order form and payment to:
   Raymond Historical Society, P.O.Box 94, Raymond NH 03077

Keep a copy of this completed form for your records
Please engrave my brick(s) with the following inscription (s):

Brick #1 (Engraver will center all type) 


 Example #1

I N   M E M O R Y          
J O H N   J   S M I T H    

 Brick #2  (Engraver will center all type)


Example #2 

H A P P Y   B I R T H D A Y
M A R G A R E T   J O N E S
A U G U S T   5 ,   2 0 0 3

 Brick #3  (Engraver will center all type)


 Example #3

M I L D R E D   E   H A L L
B O S T O N   P O S T      
C A N E   1 8 8 9 - 2 0 0 3

Questions? Call the Raymond Historical Society at 603-895-2866 or Marion Buffington at 603-895-6619.