Memorial Garden Paving Stone

Memorial Garden Paving Stone Order Form

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Please complete all information and mail this form with payment in full to (checks should be payable to Our Lady of the Chesapeake):

Our Lady of the Chesapeake 8325 Ventnor Road Pasadena, MD 21122

Please complete a separate order form for each paving stone that you are sponsoring. Please be aware that it may take up to several months for the stone to actually be placed in the Memorial Garden.

Name: ______

Date: ______

Street Address: ______

City, State, Zip: ______

Telephone: ______

Amount Enclosed ($50 per paving stone) $______

Inscription -- Please Print (14 characters each line, including spaces and punctuation)

______

___This is a Gift. Please send an acknowledgement certificate to:

Name: ______

Address: ______