Bricks Order Form

 

                              ALUMNI/MEMORIAL BRICKS

 

Please place your order by the three examples below only.    PLEASE PRINT.

EXAMPLES

Alumni                            In Memory of                       

 Jane Wilson                   John Smith    

Class of 1955                Class of 1930

 

 Teacher/VP/ Principal / Counselor

John Smith

1960 to 1980

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   4 lines per brick only   (only 21  characters per line - 18 recommended 

 

First line __________________________________________________

 

Name ____________________________________________________

 

_________________________________________________________

 

Graduation Year  _______________

 

Please print and send this application along with a check or money order for $35.00 to Wilby High School Alumni Association, PO Box 4503, Waterbury, CT 06704   Please provide an address, phone, or e-mail so we can notifly you when the bricks arrive.

Bricks are ivory with emerald green fill.