Survey - Personalized Paving Brick Order Form

Personalized Paving Brick Order Form

Another great way to remember or honor a loved
one! A limited series of outdoor paving bricks
line the sidewalk to the Wisconsin Humane Society
building. For a $250 donation, your inscription
on a 4"x8" brick can include 3 lines, with up to
14 characters per line including spaces. For a
$500 donation, your inscription on an 8"x8" brick
will include 6 lines, with up to 14 characters
per line including spaces.

Please fill out your contact information.

Name:

First Required	Middle Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Country:

Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from The Wisconsin Humane Society.

Remember me.

Question - Not Required - What type of brick would you like to sponsor

Question - Required - Which campus would you like to order a brick for?

Here is an example of how we will format your brick inscription based off your brick choice and size.

$250- 4"x8" (3 lines, 14 characters per line including spaces)

Example: _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _

$500- 8"x8" (6 lines, 14 characters per line including spaces)

Example: _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _

Question - Not Required - What would you like your brick to say based on your brick size?

Wisconsin Humane Society

Personalized Paving Brick Order Form

Please Donate!

Milwaukee Campus

Ozaukee Campus

Racine Campus

Door County Campus

Green Bay Campus

Wisconsin Humane Society