C.A.P. Buy A Brick Program
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One order form per brick.  Complete the information below and return with your check made payable to "C.A.P." to: (Please mark your envelope with “buy a brick” in the bottom corner.)

Churchill Athletic Patrons
Churchill High School
8900 Newburg Rd
Livonia, MI  48150

If any questions, please contact Ed Holton at 734-536-6864 or email at ed.holton@sbcglobal.net.

      Please choose brick size:

_________  4" x 8" brick with up to 3 lines of text -  $55.00. 
_________ 8" x 8" brick with up to 6 lines of text - $100.00. 

 ____ Send Recognition Certificate       ____ Do not send Recognition Certificate

Please CLEARLY PRINT message, including upper/lower case letters, 20 characters per line. A character includes punctuation, spaces, etc.  Messages will be centered top to bottom and left to right as bricks are produced.

Line 1 __/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__

Line 2 __/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__

Line 3 __/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__

Line 4 __/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__

Line 5 __/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__

Line 6 __/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__


***Please note:  Bricks are ordered once per year, after the school year is completed, and will be installed in the fall of that year***