Only 500 bricks are available – Say it with a Brick NOW!
Print your name exactly as you want it to appear on the brick on the form below, and be sure to check the spelling because a “brick is forever”.
4x8 bricks (cost $100) allow up to two lines 13 letters/spaces each.
Example

J a n e ___ & ___ J o h n ___ ___
1 2 3 4 5 6 7 8 9 10 11 12 13
S m i t h ___ ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7 8 9 10 11 12 13

Print your name, business or organization as you want it to appear in spaces below – using a space for each letter and space.

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7 8 9 10 11 12 13
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7 8 9 10 11 12 13

Purchaser Name ________________________________________________________________
Address_______________________________________________________________________
City __________________________________________________________________________
State _________________________________________________________________________
E-mail______________________________________________ Phone # ___________________

Authorized Signature____________________________________________________________

Make checks payable to the Waseca Area Foundation. Send check and form to
Waseca Area Foundation
111 NE 2nd Ave, Waseca, MN 56093
Amount of tax deduction is equal to $125.
Questions?: Call 507 835-5990 or e-mail WAF@hickorytech.net