____________________________________________________
Pathway to Knowledge Brick Campaign
Order Form (updated January 1, 2021)
Name ___________________________________________________________________________________________________
Address __________________________________________________________________________________________________
City __________________________________________________State ____________ Zip _____________________________
Email: ____________________________________________________________________________________________________
Daytime Phone ________________________________________________
Brick Options:
____ Inner Circle* @ $300 each Total $___________
____ Outer Circle* @ $250 each Total $___________
____ Pathway @ $100 each Total $____________
(*NOTE: Limited bricks left. Please email alumni@elgin.edu for availability.)
Make checks payable to:
Credit Card
ECC Foundation
Name on Credit Card _______________________________
Expiration Date: ______________ Security Code: _ _ _
All bricks are 4”x 8”
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:
Elgin Community College Foundation, 1700 Spartan Drive, Elgin IL 60123 Email Orders: alumni@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.
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signature
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