Engraved Brick Application

Lions Plaza at the Lions State Office Building
Offered through the Indiana Lions Foundation

Brick Options
Option 1: Standard 4x8 Brick
COST: $100.00 per brick, 3 lines maximum, 13 characters per line (including spaces)
Option 2: Large 8x8 Brick
COST: $250.00 per brick, 6 lines maximum (or 4 lines & Lions logo), 13 characters per line (including spaces)
Brick Fee Due with Application
Your Information
Name:
Address:
Club/District:
Phone #:


Logo: Yes No

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6