Butterfly Memorial Patio Brick Forms

The Butterfly Memorial Patio offers beautiful views of the pond and landscape surrounding it. The patio offers three sizes of memorial bricks that may be engraved to honor a person’s life. Memorial brick orders are placed two times per year (April and September) and installed early summer and fall.

After you fill out the form below you will be taken to a Paypal portal to complete your payment. Thank you for your support!

Small Paver Brick

Contact Name *
Name of Honoree *
Organization

Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Email *
Phone *

Line 1 (20 characters. Spaces and punctuation count as characters)

Line 2 (20 characters)

Line 3 (20 characters)

Line 4 (20 characters)

*Spaces and punctuation count as characters

To help prevent spam please enter any two digits. (Example: 12) *
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Medium Paver Brick

Contact Name *
Name of Honoree *
Organization

Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Email *
Phone *

Line 1 (20 characters. Spaces and punctuation count as characters)

Line 2 (20 characters)

Line 3 (20 characters)

Line 4 (20 characters)

Line 5 (20 characters)

Line 6 (20 characters)

Line 7 (20 characters)

To help prevent spam please enter any two digits. (Example: 12) *
This box is for spam protection - please leave it blank:

Large Paver Brick

Contact Name *
Name of Honoree *
Organization

Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Email *
Phone *

Line 1 (20 characters. Spaces and punctuation count as characters)

Line 2 (20 characters)

Line 3 (20 characters)

Line 4 (20 characters)

Line 5 (20 characters)

Line 6 (20 characters)

Line 7 (20 characters)

To help prevent spam please enter any two digits. (Example: 12) *
This box is for spam protection - please leave it blank:

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We are grateful for all gifts, large and small, which fund patient care, outreach and education programs and capital needs to continue our mission of Caring for Our Community.

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