City of Black River Falls Field of Honor
101 S. 2nd St.
Black River Falls, WI 54615
http://www.fieldofhonor.org

Yes, I would like to help out with a donation of $______________________

Name:_________________________

Address:_______________________

City:__________________________ State:______ Zip Code:__________

Phone:_________________________


Total Donation

Size of tile:

$250.00

12" x 12"

$500.00

12" x 24"

$1,000.00

24" x 24"

What name do you want on your tile?

 

Line 1:(12" x 12") ____________________________________________________

Line 2:(12" x 12"& 24") _______________________________________________

Line 3: (12" x 24")____________________________________________________

Line 4:(24" x 24") ____________________________________________________


Your tax deductible gift should be made payable to:

City of Black River Falls Field of Honor

and can be mailed to:

City of Black River Falls, Field of Honor
101 s. 2nd St. Black River Fall, WI 54615