Shelter Brick Form

Your very own commemorative brick on a special memorial path or wall…

What a great way to honor a special bird, living or passed; or to celebrate your family, a special date, person, pet or event!  The bricks will become a permanent part of the Long Island Parrot Society’s future Parrot Museum, Shelter and Learning Center!  Your sponsorship will help make the project a reality!

Three lines of engraved type, 13 spaces per line, standard size brick.

Bricks will be delivered to the LI Parrot Society and stored until needed.

Cost: $50.00 each

YES, I would like to donate___ bricks @ $50.00 each. Total: ________

Line 1: |___|___|___|___|___|___|___|___|___|___|___|___|___|

Line 2: |___|___|___|___|___|___|___|___|___|___|___|___|___|

Line 3: |___|___|___|___|___|___|___|___|___|___|___|___|___|

Attach a separate piece of paper for additional bricks.

NAME:_______________________________________________________________________________

ADDRESS:____________________________________________________________________________

PHONE:_______________________________________ E-MAIL:_________________________________

Please enclose a check or money order and mail to:

THE LONG ISLAND PARROT SOCIETY

P.O. BOX 2754

NORTH BABYLON, NY 11703

Telephone (631) 957-1100 ~ email:  info@liparrotsociety.org

The LI Parrot Society is a non-profit, 501c3 organization.

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