City of Black River
Falls Field of Honor
101 S. 2nd
St.
Black River Falls, WI
54615
http://www.fieldofhonor.org
Yes, I would like to help out with a donation of $______________________
Name:_________________________
Address:_______________________
City:__________________________ State:______ Zip Code:__________
Phone:_________________________
|
Total Donation |
Size of tile: |
|---|---|
|
$250.00 |
12" x 12" |
|
$500.00 |
12" x 24" |
|
$1,000.00 |
24" x 24" |
What name do you want on your tile?
Line 1:(12" x 12") ____________________________________________________
Line 2:(12" x 12"& 24") _______________________________________________
Line 3: (12" x 24")____________________________________________________
Line 4:(24" x 24") ____________________________________________________
Your tax deductible gift should be made payable to:
City of Black River Falls Field of Honor
and can be mailed to:
City of Black River
Falls, Field of Honor
101 s. 2nd
St. Black River Fall, WI 54615