Engraved Brick Order Form

Print this page, fill out and mail, along with your check, to  the Kansas Firefighters Museum, 1300 S. Broadway, Wichita KS 67211. Bricks are $30 each. Use only one character (letter, number, punctuation, mark or space) per square.

I want our personalized engraved brick to say the following.

Brick 1              Group Affiliation_______________________

oooooooooooo
oooooooooooo
oooooooooooo

Brick 2         Group Affiliation_________________________

oooooooooooo
oooooooooooo
oooooooooooo

 

Note: The Firefighters Maltese Cross is available for an additional $1 per brick. The emblem will use one space. Other emblems will be available for an additional cost. Group orders must be mailed together.

Customer__________________________________________________Phone_________________________

Address__________________________________________________________________________

City State/Zip______________________________________________________________________

Thank you for your support!