Lewis

Educating and Supporting Children and Families since 1966

Lewis-Clark Early Childhood Program
Bricks Order Form

Please print and complete the following form and mail to: Lewis-Clark Early Childhood Program, 1816 18th Avenue, Lewiston, ID 83501.

At only $25 for a one line or $50 for a two line inscription, you can help to preserve this historical site and extend its legacy of support to families and children. (Donations are tax deductible).

Name:
Phone:
Address:
City, State and Zip:
Enclosed is my order for	bricks and my check for $__________.

Please print in UPPER CASE BLOCK LETTERS.	Up to 20 Characters per line
Brick 1:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Brick 2	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
If you have any questions please call 208-743-6573.