Brick Donation Form

The Boys & Girls Club is offering supporters the opportunity to purchase a brick at the Los Angeles Boys & Girls Club. The brick can be in your name, a gift for a friend, in memory of, or on behalf of a corporation and it will be part of “The Wall of Inspiration”.
The Brick is 8”x4”x2” with black printing
Sample:

Name: Richard E Kalk

Message/Title: Board Member

Support/Brick Level: Options available below
First Line Text (16 character limit)
Second Line Text (16 character limit)
Third Line Text (16 character limit)
Purchase Brick Level:*
- $5000 Benefactor
- $2500 Champion
- $500 Hero
- $250 Friend
- $100 Supporter
- Other Amount
Other Donation Amount
Billing Information
Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Total
$0.00

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