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:
Joe Sadler Chairman of "The Affirmation of Life" Memorial, Knights of Columbus Committee
Mike Cowan Vice Chairman of "The Affirmation of Life" Memorial, Knights of Columbus Committee
The Knights of Columbus reserves the right to deny any inappropriate submissions