Prescott Fire Department Memorial Statue Brick Registration Form $125.00 supports the Copper Level; the sponsor receives a 6"x 9” engraved brick with up to three lines of text. $500.00 supports the Silver level; the sponsor receives a I2"x 12" engraved brick with up to three lines of text. $1,000.00 supports the Gold Level; the sponsor receives a I2"x 12" engraved brick with up to three lines of text, and the sponsor receives a rosewood engraved Fire Department plaque for display. $5,000.00 or more supports the Bronze Level; the sponsor receives a I2"x 12" engraved brick with up to three lines of text or company logo, and also receives a rosewood engraved Fire Department plaque for display along with company or family name on a bronze plaque that will be placed outside near the statue. Name ______________________________________________________________ Address ____________________________________________________________ City _____________________________ zip ________________________________ Phone _______________________ Email __________________________________ Flagstaff Fire Department Memorial Statue Committee 1972 S. Thompson Street Kristin Smith, Battalion Chief 928.213.2523 Tax ID 42-1667576 www.Flagstafffirememorialstatue.org
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