EmailMe Form - GCSP - Blue Star Memorial Brick Form (REVISED)

Name *
First Last
Phone *
### - ### - ####
Email
Are you a member of the Garden Club of St. Peterburg? *
Yes
No
Commemorative Brick - $50.00
Please select the number of Commemorative Bricks you will be paying for today *
The commemorative brick has 3 rows that each have room for a maximum of 15 characters across, INCLUDING SPACES. Type your message exactly as you want it to appear. Please verify all spelling and numbers/dates as this form will be the reference for the production of your engraved brick.
Row 1
Row 2
Row 3
After clicking the "Submit" button please wait as sometimes it will take a moment before you are automatically redirected to PayPal. Remember is you wish to pay by check, simply close the PayPal window and submit your check to the Garden Club. Please only click the "Submit" button once.

**To avoid duplicate submissions, please only click "Submit" once. It may take a moment for the form to process and move to the next page.**