_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_____________________________________________
$____________
$___________
$___________
Pathway to Knowledge Brick Campaign
Order Form
Name ____________________________________________________________________________________________________
Address __________________________________________________________________________________________________
City __________________________________________________ State ____________ Zip _____________________________
Email ____________________________________________________________________________________________________
Daytime Phone ________________________________________________
Brick Options:
____ Inner Circle @ $200 each Total
____ Outer Ci
rcle @ $150 each Total
____ Pathway @ $50 each Total
Make checks payable to:
ECC Foundation
Credit Card
Expiration Date: ______________ Security Code _ _ _
Signature
14 spaces / 3 lines of text
Please PRINT EXACTLY as you would like the engraving to appear using one character/letter per box leaving a
blank for each space between words.
Mail this form and payment to: Fax Orders: 847-214-7537
Elgin Community College Foundation, 1700 Spartan Drive, Elgin IL 60123 Email Orders: ECCalumni@elgin.edu
Your gift is tax deductible to the extent allowed by IRs regulations for gifts to Foundations of state educational institutions
(see publication 526, available from the IRS Website.) Proceeds benefit the ECC Alumni Program Fund.
