The College of Health and Human Performance

Memorial Walk Brick Paver Order Form

Complete the form below and submit to order your brick paver. Each brick has 3 lines, with a maximum of 11 characters per line including spaces and punctuation. You will need to call 252-328-9572 and provide credit card information after you submit the form in order to complete your order.


(11 character max)

(11 character max)

(11 character max)

   
   
 
 

Samples

1LT J.BROWN
U.S. ARMY
1962-1967
COL.J.ADAMS
AIR FORCE
1954-1984
LCPL.JOSEPH
WORTHINGTON
61-64 USMC
CAPT LEE
COAST GUARD
KIA IRAQ 99