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