TLC Trail Marker and Paver Order Form

Athlete & Volunteer Recognition Wall Order Form

Gold/Silver/Bronze Medallion
ORDER DETAILS
Submittal Date *

- Month - Day Year
Date
Select Type of Medallion *
BRONZE 5" MEDALLION LEVEL ($500)

UP TO 40 CHARACTERS MAXIMUM
SILVER 6" MEDALLION LEVEL ($1,000)

UP TO 50 CHARACTERS MAXIMUM
GOLD 7" MEDALLION LEVEL ($2,000)

UP TO 60 CHARACTERS MAXIMUM
Wording (limit 40 characters)
Wording (limit 50 characters)
Wording (limit 60 characters)
DONOR INFORMATION
Contact First Name *
Contact Last Name *
E-mail Address *
Phone Number *
Extension
Street Address (no PO Boxes) *
City *
State *
Zip Code *
This address is a: *

Residence Business, School or Facility
* Notify us if there is a discrepancy by calling Laurie at 913-789-0353.
Should be Empty: