RuritanClubandDistrictOfficersHandbook

Ruritan Paver Program for Capital Improvement The Ruritan Paver Patio is a beautiful place to remember loved ones and honor special Ruritans. The funds raised with this program will be used for capital reserves and to make improvements to the building. Complete this form and send in with your payment to Ruritan National, P.O. Box 487, Dublin VA 24084

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4 x 8 Brick; three lines of type - only 20 characters or spaces per line $100

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8 x 8 Brick, 6 lines of type - only 20 characters or spaces per line $200

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8 x 8 Brick; three lines - 20 characters or spaces per line PLUS Ruritan Emblem $210

I would like a tile coaster replica as a remembrance for $25

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Total enclosed for this brick: $_____________

Name: _____________________________________ Phone: _______________

Email: ____________________

Card # ______________________________ Expiration Date:_________________

Code on reverse: ________

Signature: _________________________________

Name and address: ____________________________________________________________________ This is a gift, please send an acknowledgement to:

Ruritan Staff Notes: Date received ___________; Acknowledgment sent _____________

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Revised 8/2021