EmailMe Form - Hummelstown Parks Brick Fundraiser

Choose Your Brick *

4” x 8” bricks can have up to 3 lines of text , 20 characters per line without clip art and 16 characters with clip art

Select the Park

Click to display or hide clip art.

Please add clip art (Add $25)

Please include a Mini Replica Brick for my home or office (Add $30)

Line 1:

Line 2:

Line 3:

Choose Your Clip Art

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Phone *

### - ### - ####

Email *