42nd Anniversary Spring Gala

Círculo de la Hispanidad Center 605 Peninsula Blvd. Hempstead, New York 11550

Círculo de la Hispanidad Partners After-School Long Beach írculo de la Hispanidad Partners After-Sch ol Long Beach

B uy A B rick P rogram R equest A P ledge F orm

Círculo de la Hispanidad’s commemorative brick program is a wonderful way to recognize a loved one or to show your support to the organization. Funds raised through this project help us reach our dream to complete and maintain our “green” Center. To make your pledge please fax a copy of this form or forward via e-mail or US Postal Service to our office at the addresses listed on this form. A separate form must be used for each brick you wish to inscribe. Please keep a copy for your personal records.

• 6“ X 6“ BRICK C ontribution L evels

This brick includes 9 characters per line including spaces and has four rows total. Use the format sample below to fit your message using 1 box per letter or space. Use this format as a sample to order additional inscriptions.

Individual Rate

$100

Friend Rate

$175

$250

Supporter Rate

• 6“ X 9” BRICK

This brick includes 14 characters per line including spaces and has four rows total. Use the format sample below to fit your message using 1 box per letter or space. Use this format as a sample to order additional inscriptions.

$150

Individual Rate

$300

Friend Rate

$500

Supporter Rate

Contact Círculo de la Hispanidad for an order form and additional instructions. Círculo reserves the right to approve all brick pledges, contributions are tax deductible. Contact Information: Eveleyn Tavarez Tel: (516) 431-1135 Fax: (516) 431-2307

e-mail: lkringel@cdlh.org website: www.cdlh.org

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