I would like to support the F-M Education Foundation's Brick-by-Brick program.
To review engraving instructions and pricing, click
here.
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For A Student __ __ __ __ __ __ __ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __ __ __ __ __ __
(Use 2nd line for extremely long names only)
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For A Teacher, Administrator, Volunteer,
Parent, or Community Member __ __ __ __ __ __ __ __ __ __ __ __ __ __
Class of __ __ __ __ |
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For School Clubs, Organizations and Teams
__ __ __ __ (school year)
__ __ __ __ __ __ __ __ __ __ __ __ __ __ (if needed) |
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For A Deceased Student, Teacher, Administrator,
or Community Member
In Memory Of __ __ __ __ __ __ __ __ __ __ __ __ __ __
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___ Yes, I would like a Foundation brick certificate (for gift giving) as inscribed above.
Make checks payable to:
"F-M Education Foundation"
Credit Card Information:
Print Name on Card: _________________________________ |
Card Number: ______________________________________ |
___ VISA or ____ Master Card |
Expiration Date: _______________________ |
Card Code: __________ (last 3 digits on signature line on back of card) |
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Submitted By: |
Name: _____________________________________________ |
Address: ___________________________________________ |
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City, State, Zip: ______________________________________ |
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Phone: _____________________________________________ |
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Date Submitted: _______________ Amount: $__________ |
| Return To: | F-M Education Foundation |
| 8199 East Seneca Turnpike | |
| Manlius, New York 13104-2140 |