Boler's Inn Memory Walkway Brick Order Form

I would like to purchase a BRICK in memory or in honor of

NAME:______________________________________________________________________________

to be placed in the Memory Walkway at Boler's Inn.

Each BRICK has 14 letters per line, maximum 2 line limit, as to ensure a brick that all will be able to read.  The cost of each Brick is $35.00 and must be paid for before the Brick will be ordered and placed in the walkway.

To order, please print this form and mail with your $35 check made payable to "Boler's Inn" to the following address:

Boler's Inn Memory Walkway
100 Highway 494 East
Union, MS 39365

Inscription to be engraved on the Brick.  (Please check your spelling and dates before mailing the order form.)

Line 1:______________________________________________________________________________

Line 2:______________________________________________________________________________

Ordered By:

Name:_______________________________________________________________________________

Address:_____________________________________________________________________________

Telephone:___________________________________________________________________________

E-Mail:______________________________________________________________________________

Thank You for your support of this project.
Boler's Inn Foundation