MCC Commemorative Bricks
Each brick is $150. Please complete both sides of this form and mail with
payment to: MCC Foundation, Inc., PO Box 1046, MS #6, Manchester,
Brick Text: maximum of 20 characters per line. Print in UPPERCASE LETTERS in the blocks provided below.
Each space counts as one character.
Please contact Diana Reid 860-512-2909 or firstname.lastname@example.org with any questions.
Your Name: _________________________________________________________________________________
Your Address: ____________________________________City/State/Zip________________________________
Phone: __________________________ Email: ____________________________________________________
MCC Alum Year (if applicable): __________________
Please notify me when the brick has been installed.
This gift is being made In Honor Of / In Memory Of _____________________________________________
Please acknowledge this gift by sending a letter of acknowledgement to the following individual: