Deterrent Park                                                                                                                Gertrude Check

Deterrent Park

Brick Application ($40/Brick Donation)

(IRS Tax Deductable)

Type in Data, Print Out Form, Sign, Date and Send in with Check or Money Order made out to USSVI Bremerton Base

Mail to:

USSVI Bremerton Base

PO Box 465

Silverdale WA 98383-0465

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Rev:11/20/2010

NAME   

STREET ADDRESS:   
CITY:     STATE:     ZIP:   
PHONE:     E-MAIL:   

COMMENTS:   

Enter your inscriptions below; Up to 15 characters and/or spaces per line.  Each brick will be engraved with capital letters, and each line will automatically centered.

 

1ST BRICK

        Line #1              Example:   JOHN PAUL JONES

        Line #2                                  FATHER OF THE

        Line #3                                  AMERICAN NAVY

2ND BRICK

        Line #1              Example:   IN MEMORY OF                    

        Line #2                                 JOHN DOE 

        Line #3                                 CDMC(SS)    

             

Please make check or money order payable to: "USSVI Bremerton Base"
MAIL TO: United States Submarine Veterans, Bremerton Base, PO Box 465, Silverdale WA 98383-0465

 Signature____________________________________________Date_________________________

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Deterrent Park                                                                                                                Gertrude Check