The Southern Maryland Carousel Group, Inc.

Name:  ______________________________________________________________
Mailing Address:  ___________________________________________________
______________________________________________________________________
______________________________________________________________________
Phone Number: ____________________________________________________

Send your tax deductible check or money order to:


Southern Maryland Carousel Group, Inc.
Post Office Box 2335
La Plata, MD 20646


Number of 4" x 8" bricks:  ___________
Number of 8" x 8" bricks:  ___________


Inscription:  One-, two-, or three-line inscription for each brick.  Each line must be no longer than 15 characters including spaces.  If additional lines for inscriptions are needed, please use a blank sheet of paper and attach to order form.


Brick No. 1
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Brick No. 2
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Brick No. 3
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BRICK ORDER FORM

BUY-A-BRICK PROGRAM

You can help with the landscaping by placing special memorial bricks around the complex.  For $100 each, you can buy a brick with up to three lines of text, with a maximum of 15 letters per line including spaces.  The bricks measure 4" x 8" x 2-1/2".  For $1,000 each, you can buy a brick that measures 8" x 8" with up to three lines of text, with a maximum of 15 letters per line including spaces. Purchase a brick to honor your family, memorialize a loved one, or recognize a special person or event.

To purchase bricks, send us your name, address, and phone number, and the number of bricks desired. Include a one-, two- or three line inscription desired for each brick. Each line must be no longer than 15 characters including spaces.

Copyright © The Southern Maryland Carousel Group, Inc. All Rights Reserved.