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MedWish Building Brick ($500)
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Contact Information

First Name
Last Name

First Name
Last Name

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

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With your donation of $500, one brick will be inscribed with your name or the name of your honoree. Please insert the text that you want inscribed on the brick. There is an option of having up to 3 rows on the brick, each row has the maximum of 20 characters each. Please note that each letter, numeral, punctuation or space counts as a character. Tax deductible amount: $470.
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