CAMP RANDALL 100 BRICK WALK ORDER FORM
CAMP RANDALL 100 BRICK WALK ORDER FORM Cement my name in UW history with a personalized brick! Limited time only!
Purchaser’s Name
Patron #, if known
Mailing Address City
State Zip
Home Phone Other Phone
PAYMENT INFORMATION: ¨ Check *Make checks payable to UWF-Athletics ¨ Credit Card: ¨ American Express ¨ Discover
¨ MasterCard ¨ Visa
Credit Card #: Expiration Date:
Email Address
Signature:
I am purchasing a brick as a gift for (if applicable): ORDER:
Recipient’s Name
TOTAL BRICK ORDER
Mailing Address City
State Zip
$ $
Please add any additional comments below:
Home Phone Other Phone ¨T his is a surprise gift. Please send acknowledgement letter to purchaser.
(If not checked, recipient will receive letter of acknowledgement directly.)
Send form to:
Wisconsin Athletic Development Office Kellner Hall | 1440 Monroe Street | Madison, WI 53711 (Photo copies of this form will be accepted)
$100 | 4”x 8” Brick
2 lines of engraving with 12 characters per line, including spaces and punctuation marks
Your contribution is 100% tax deductible, will earn credit in the Wisconsin Athletics Priority Point System, and count toward your annual giving level and related donor benefits. Camp Randall 100 bricks ordered by June 15, 2017 will be installed at the end of August. Camp Randall 100 bricks ordered June 16- September 15, 2017 will be installed in October, prior to Homecoming. For more information, please contact the Wisconsin Athletic Development Office at (608) 262-1000 or [email protected].
Purchaser’s Name
Patron #, if known
Mailing Address City
State Zip
Home Phone Other Phone
PAYMENT INFORMATION: ¨ Check *Make checks payable to UWF-Athletics ¨ Credit Card: ¨ American Express ¨ Discover
¨ MasterCard ¨ Visa
Credit Card #: Expiration Date:
Email Address
Signature:
I am purchasing a brick as a gift for (if applicable): ORDER:
Recipient’s Name
TOTAL BRICK ORDER
Mailing Address City
State Zip
$ $
Please add any additional comments below:
Home Phone Other Phone ¨T his is a surprise gift. Please send acknowledgement letter to purchaser.
(If not checked, recipient will receive letter of acknowledgement directly.)
Send form to:
Wisconsin Athletic Development Office Kellner Hall | 1440 Monroe Street | Madison, WI 53711 (Photo copies of this form will be accepted)
$100 | 4”x 8” Brick
2 lines of engraving with 12 characters per line, including spaces and punctuation marks
Your contribution is 100% tax deductible, will earn credit in the Wisconsin Athletics Priority Point System, and count toward your annual giving level and related donor benefits. Camp Randall 100 bricks ordered by June 15, 2017 will be installed at the end of August. Camp Randall 100 bricks ordered June 16- September 15, 2017 will be installed in October, prior to Homecoming. For more information, please contact the Wisconsin Athletic Development Office at (608) 262-1000 or [email protected].
