Please only fill this form out AFTER you have made a minimum donation of $175.

If you have not already made a donation, please click here to do so.

The brick will have three lines available of 18 characters per line (spaces and punctuations are included in the character count). All of the bricks are 8 inches by 4 inches and will be in Times New Roman font. There are no symbols or logos allowed on the bricks.

*Please Note*

You will have to fill out and submit this form for each brick you would like to purchase. This may require you to fill out and submit this form multiple times.

If you have any questions, please reach out to Marybeth Kelly at mbkelly@awhs.org or 781-843-3610.