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print and mail
Please reserve my space in the Walk of Fame!
 4 x 8 regular brick
with black lettering - $100
4 x 8 Golden Wings brick - $500
8 x 8 Black Granite
Brick - $1,000
Please provide the brick engraving information using the form below
the example. Please use one character per box only, including spaces and
punctuation. See example below.
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M
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O
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Use this below to indicate choice of wording. (14
characters by 2 rows for 4 x 8 brick, 14 characters by 5 rows for 8 x 8 brick.)
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8x8 brick (5 rows)
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4x8 brick (2 rows)
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YES, Please reserve my commemorative plaque of the grand opening of the AMA administrative building -
$100
Name________________________________________________________
AMA No. ______________
Address ____________________________________________________________________________
City____________________________________ State___________________ ZIP________________
Payment Type VISA
MasterCard Check
Money Order
Account No. __________________________________________________ Exp.__________________
Signature ___________________________________________________________________________
Call (765) 287-1256 ext., 261; Fax to (765) 289-4248; or mail to AMA, 5161 E. Memorial Dr., Muncie IN 47302.
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