Brick Paver Form

2. Pavers are still available!
   Over 400 brick pavers have been engraved and installed in the council ring between the two play areas at Patriots Park. There are 200 more bricks available for engraving. Show your commitment to Riverside Parks & Recreation by setting it in stone! <br><br> Because the pavers have now been installed, on-site engraving costs are higher than the pre-installation cost, but each brick purchased helps the Parks & Recreation Department achieve the goal of funding the construction of Patriots Park without the use of tax dollars. For $300, you can have a brick engraved with your family name or the name of a loved one. This is a wonderful way to pay tribute to someone who loves Riverside.

   Over 400 brick pavers have been engraved and installed in the council ring between the two play areas at Patriots Park. There are 200 more bricks available for engraving. Show your commitment to Riverside Parks & Recreation by setting it in stone!
   
   Because the pavers have now been installed, on-site engraving costs are higher than the pre-installation cost, but each brick purchased helps the Parks & Recreation Department achieve the goal of funding the construction of Patriots Park without the use of tax dollars. For $300, you can have a brick engraved with your family name or the name of a loved one. This is a wonderful way to pay tribute to someone who loves Riverside.

3. 

5. First Name

6. Last Name

8. Email Address

10. Address

12. City

13. State

14. Zip Code

16. Inscription

    Maximum 20 Characters including spaces.

17. Electronic Signature

19. Please complete this form then mail your payment of $300.00 to:<br><br> Riverside Recreation Department <br>Attention Buy-A-Brick Fund <br>27 Riverside Road <br>Riverside, IL 60546

    Please complete this form then mail your payment of $300.00 to:
    
    Riverside Recreation Department
    Attention Buy-A-Brick Fund
    27 Riverside Road
    Riverside, IL 60546

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21. 1. Receive an email copy of this form.
22. Email address

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