To Order a Paver, please PRINT this form and fill out. Limit one letter per space.
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Please return this form with your check. Your donation is TAX DEDUCTIBLE. Please provide your address if you would like a statement of your contribution. Please make out check and mail to:
Knights of Columbus Council 11217
18033 15th Place NE
Shoreline, WA 98155
Donor Name: _____________________________________ Telephone: _______________________
Address: _________________________________________________________________________
Pavers are $100 each
You may also make a donation or pledge amount
___ $25 ___ $50 ___ $100 ___ $500 ___ $1000 ___ Other _____
Your donation is TAX DEDUCTIBLE. Please provide your address if you would like a statement.
Questions? Contact:
David Reed (425) 361-5421 St Mark Parish
Mike Cowan (206) 779-6127 Financial Secretary
The Knights of Columbus reserves the right to deny any inappropriate submissions