Buy a brick and leave a lasting legacy in the courtyard at the PNET IMR m elon rear tC BS Cll Rem debti = National Museum of Racing and Hall of Fame Courtyard Brick Order Form ll Please print the name or message exactly as you wish it to appear on the brick. Each 4x8 brick has room for 3 lines of copy with 18 characters per line, including spaces and punctuation. Each 8x8 brick has room for 6 lines of copy with 18 characters per line, including spaces and punctuation. ‘The Museum reserves the right to refuse any ‘messages deemed inappropriate and return payment to the purchaser. Your donation is tax deductible. The brick is symbolic of the donation and does not entitle the donor to ownership of the brick. Your Name, Address, City/State/Zip Telephone Email [My check is enclosed and made payable to the National Museum of Racing Oo You may charge my: ___ Visa. __ MasterCard. __—sAmEx = _ Discover Name on Card Card Number: Expiration Date: Security Code: Signature: [D)s250 sx8 Border Gray Brick (6 lines) []st00 4x8 inner Red Brick (3 lines) PLEASE PRINT CLEARLY AND CAREFULLY. If you would like to order more than one brick, please use a separate piece of paper and attach it to this document. || 48 ¢ 8x8 (6) lines If your brick is in honor of someone else and you would like us to notify that person, please list their name and address below. Name Address City/State/Zip If you need more forms or information, call the Development and Membership Officer at (518) 584-0400 ext. 109 or email nmrmembers@racingmuscum.net. All contributions are tax deductible, Send completed forms and payment to: National Museum of Racing and Hall of Fame | 191 Union Avenue} Saratoga Springs, NY 12866