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!
   
   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:
    
    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

    This field is not part of the form submission.

23. Submit

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