The Commemorative Brick Program is Back!
This is a wonderful opportunity to commemorate your family, remember a loved one, honor a friend or promote your business!
For an order form, stop into the Green Lake Area Chamber of Commerce to receive a hard copy!
Commemorative Brick Program
A Piece of History in Deacon Mills Park by the Wharf
An opportunity to commemorate your family, remember a loved one, honor a friend or promote your business!
Office Use
Name: ______________________
Check No. ___________________
Amount $: ___________________
ORDER INFORMATION: Each brick is $100
Pay by check, money order or credit card. Duplicate form for more
than one brick order
MAIL FORM: Green Lake Area Chamber of Commerce
PO Box 337, Green Lake, WI 54941
Once 30 brick orders are collected, they will be delivered to
the engraver and you will be notified.
4” x 8” x 2” Brick
Message will be centered in capital letters
BUYERS INFORMATION: (please clearly print with pen or type)
Name: _______________________________________________
Address: _____________________________________________
City: _______________________ State: _______ Zip: _________
Phone: _____________________ Date: ____________________
Email: _______________________________________________
Payment Enclosed for $ ____________ (payable to GLACC)
Please Charge $ ______________VISA_____ Master Card_____
Name On Credit Card: _______________________________________ Zip Code of Billing Address: _______________
Credit Card Number: __________________________________Exp Date: ____________ Security Code:___________
ENGRAVING INFORMATION
▪ Your brick can have three lines with 12
characters per line (including spaces and
punctuation)
▪ Space one block between words
▪ To order additional bricks, copy form.
▪ The City of Green Lake reserves the
right to refuse to engrave any message
or material that it determines to be
inappropriate. If you need additional
information, please email
allison@visitgreenlake.com or call
(920)294-3231
Be a Permanent Part of
Green Lake’s History!
Your $100 donation is tax deductible to
the extent allowed by law
