Organization _____________________________________________________________________
Adress __________________________________________________________________________
City______________________________________State ____________________Zip____________
Phone _________________________________Fax ______________________________________
Email ___________________________________________________________________________
Message to be engraved on 8"x 4" or 6"x 9" (VIP & LOGO) BRICKS ( 3 lines/13 spaces per
line maximum): (Please note: 8"x 4" Bricks will be located on front sidewalk and 6"x 9" VIP & LOGO bricks will be located under the grape arbor)
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LOGO's are individually priced. (Please attach camera-ready sample). The name of the
organization, however, must be engraved on a separate VIP brick. (Prices below)
Please circle your choice:
One Line $50.- Two Lines $ 75.- Three Lines $ 100.-
*VIP One Line $ 150.- *VIP Two Lines $ 175.- *VIP Three Lines $ 200.
Please mail this completed form with your payment in US Dollars to:
American Labor Museum, 83 Norwood Street, Haledon NJ 07508