ADD YOUR LIGHT TO THE PATH OF SPIRITUALISM
The Fox Property Project -  Hydesville, New York, U.S.A.
The National Spiritualist Association of Churches of the United States of America (NSAC) invites you to be a part of a very special, yet limited commemorative opportunity.  On March 31, 1998 the NSAC acquired the "Fox Property" in Hydesville, New York.  The property, where the famous "Fox Cottage" once stood became known as the birthplace of Modern Spiritualism on March 31, 1848.  Plans are underway for the creation of Hydesville Memorial Park and you can be a permanent part of the park!  By making a donation for a paver or bench you will see your name, the name of a loved one, your church or Spiritualist organization on the path of Spiritualism.
CONTACT INFORMATION INSTRUCTIONS
Name: __________________________________________________________________ ORDERING INFORMATION:
   Please print clearly
ENGRAVING INFORMATION:

   Write one letter per box
   Spaces & punctuation count
   Check spelling!
DELIVERY INFORMATION:
   Bricks ordered in lots of 100
   Bricks laid in delivery order
Address: __________________________________________________ Apt:____________
City: __________________________  State/Prov.:_____________  Zip:____________
Country: _________________________________________________________________
Phone: Day:__________________ Night:__________________ Fax:_________________
eMail: _________________________________________________________________
     
ORDERING INFORMATION
ITEM SIZE ENGRAVING IMAGE ON PAVER PRICE   QUAN   AMOUNT
Bench Line 1: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| 20/Line $2,500 x _____ = _______
Line 2: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Line 3: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Diamond
Paver
4"x8"
Line 1: |__|__|__|__|__|__|__|__|__|__|__|__|  12 Char/Line
$1,000 x _____ = _______
Line 2: |__|__|__|__|__|__|__|__|__|__|__|__|
Line 3: |__|__|__|__|__|__|__|__|__|__|__|__|
Emerald
Paver
4"x8"
Line 1: |__|__|__|__|__|__|__|__|__|__|__|__|  12 Char/Line
$500 x _____ = _______
Line 2: |__|__|__|__|__|__|__|__|__|__|__|__|
Line 3: |__|__|__|__|__|__|__|__|__|__|__|__|
Sapphire
Paver
4"x8"
Line 1: |__|__|__|__|__|__|__|__|__|__|__|__|  12 Char/Line
$250 x _____ = _______
Line 2: |__|__|__|__|__|__|__|__|__|__|__|__|
Line 3: |__|__|__|__|__|__|__|__|__|__|__|__|
Ruby
Paver
8"x8"
Line 1: |__|__|__|__|__|__|__|__|__|__|__|__|  12 Char/Line
$100 x _____ = _______
Line 2: |__|__|__|__|__|__|__|__|__|__|__|__|
Line 3: |__|__|__|__|__|__|__|__|__|__|__|__|
Regular
Paver
4"x8" Line 1: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| 20/Line $50 x _____ = _______
Line 2: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Line 3: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
PAYMENT INFORMATION
Payment Type:
____Visa   ____Master Card   ____Check
TOTAL # _____ $ _______
Card/Check#: _________________________________  Expiration Date: ___________
Name on Card: ___________________________________________________________
Signature: ____________________________________    Date: ____ / ____ / ____ YOUR
DONATION
IS FULLY
TAX DEDUCTIBLE!
   
RETURN COMPLETED FORM AND PAYMENT TO:
Attn: Fox Property Project
National Spiritualist Association of Churches
13 Cottage Row, PO Box 217, Lily Dale, NY 14752, USA
Phone:  716-595-2000      Fax: 716-595-2020