Hospice of Union County

Enclosed is my donation of $ to Hospice of Union County dated

Name : ____________________________________________

Address: ___________________________________________

City/State/Zip : ______________________________________

Phone: ____________________________________________

(Engraving is limited to 18 characters per line, three lines per brick)

The name(s) or organization and text to be engraved on the brick or plaque is as follows:

_____________________________________________________________________

_____________________________________________________________________
(possible inscription: In memory of Jane Doe by The Executive Corporation
or In Honor of Jane Doe by John Doe)

The name(s) to be placed on the "Tree of Life" inside the building is:

_____________________________________________________________________

_____________________________________________________________________
(possible inscription: The Executive Corporation or John Doe)

If the brick or plaque is in memory of someone and you would like the family or individual to be notified of your donation, please complete the following:

This brick or plaque is in honor/memory (circle one) of:

_____________________________________________________________________

Acknowledge donation to (name and address):

_____________________________________________________________________

Hospice of Union County, Inc. is an non-profit organization. All gifts are tax deductible to the full extent as provided by law.



		Back "Walk of Life" Commemorative Bricks and Plaques Contributions from the community are vital to Hospice of Union County in our effort to provide care to the terminally ill patients and their families that we serve. On the Hospice Center grounds there is a "Walk of Life" that commemorates the lives of some of the patients that have been cared for over the past 20 years. There are two ways to commemorate loved ones on the "Walk of Life". Donors of $100.00 or more can purchase an engraved brick that will line the "Walk of Life" at the Hospice Center. For donations of $1000.00 or more, donors may purchase an engraved plaque that will line the Walk at Hospice Center. If you would like to order a brick or plaque, please complete the following information , print, sign and mail to: HOSPICE OF UNION COUNTY, 700 W. ROOSEVELT BLVD., MONROE, NC 28110
	I would like to purchase brick(s) at $100.00 each. Enclosed is my donation of $ to Hospice of Union County dated I would like to purchase plaque(s) at $1000.00 each. Enclosed is my donation of $ to Hospice of Union County dated Name : ____________________________________________ Address: ___________________________________________ City/State/Zip : ______________________________________ Phone: ____________________________________________ (Engraving is limited to 18 characters per line, three lines per brick) The name(s) or organization and text to be engraved on the brick or plaque is as follows: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ (possible inscription: In memory of Jane Doe by The Executive Corporation or In Honor of Jane Doe by John Doe) The name(s) to be placed on the "Tree of Life" inside the building is: _____________________________________________________________________ _____________________________________________________________________ (possible inscription: The Executive Corporation or John Doe) If the brick or plaque is in memory of someone and you would like the family or individual to be notified of your donation, please complete the following: This brick or plaque is in honor/memory (circle one) of: _____________________________________________________________________ Acknowledge donation to (name and address): _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Hospice of Union County, Inc. is an non-profit organization. All gifts are tax deductible to the full extent as provided by law.