Memorial Bricks Order Form Please call one of the committee members if you need additional information: Joan Murphy: 262-914-3855 Cheryl Poisl: 262-859-2591 Marylin Zirbel: 262-857-2417 Orders received after February 29 to be installed the following year. To order a memorial brick for a resident or former resident of the Town of Paris, please fill in the following form. How many bricks would you like to order?(Required)1 Brick2 Bricks3 BricksThis field is hidden when viewing the formSamplesSample - 1 Line JACK TAYLORSample - 2 Lines JACK TAYLORSample - 3 Lines JACK TAYLORFAMILYPlacement of bricks at discretion of committee.Brick 1If Applicable, Indicate Group: (For Military- Name, Rank, Branch of Service)Line 1 (Maximum 13 characters)Letters, spaces, or punctuation is accepted.Line 1 Alignment Left Center Right Line 2 (Maximum 13 characters)Letters, spaces, or punctuation is accepted.Line 2 Alignment Left Center Right Line 3 (Maximum 13 characters)Letters, spaces, or punctuation is accepted.Line 3 Alignment Left Center Right Please include a description of the person/family history in Paris to be included in the Town's anthology.Brick 2If Applicable, Indicate Group: (For Military- Name, Rank, Branch of Service)Line 1 (Maximum 13 characters)Letters, spaces, or punctuation is accepted.Line 1 Alignment Left Center Right Line 2 (Maximum 13 characters)Letters, spaces, or punctuation is accepted.Line 2 Alignment Left Center Right Line 3 (Maximum 13 characters)Letters, spaces, or punctuation is accepted.Line 3 Alignment Left Center Right Please include a description of the person/family history in Paris to be included in the Town's anthology.Brick 3If Applicable, Indicate Group: (For Military- Name, Rank, Branch of Service)Line 1 (Maximum 13 characters)Letters, spaces, or punctuation is accepted.Line 1 Alignment Left Center Right Line 2 (Maximum 13 characters)Letters, spaces, or punctuation is accepted.Line 2 Alignment Left Center Right Line 3 (Maximum 13 characters)Letters, spaces, or punctuation is accepted.Line 3 Alignment Left Center Right Please include a description of the person/family history in Paris to be included in the Town's anthology.Contact InformationOrdered By First Last Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneTotal