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Noah's Quest Brick Order Form
Noah's Quest is a community event for bereaved parents and those that support them. Each year bricks are engraved with the names of babies who have died and placed on a brick pathway in Sandy, Oregon.

If you would like to order a brick in memory of your child, please complete the form. Bricks include up to 3 lines of text and 14 characters (including punctuation and spaces) on each line.

Pricing:

Bricks are $50.00 each. Bricks with graphics are $55.00 each. Payment should be made on the Brief Encounters website through the PayPal link located at at Step 2 on the homepage.

*** Brick order form is due by May 14th, 2018 ***

Email address *
Name of person ordering (First and Last) *
Your answer
Phone Number *
Your answer
Line #1 Each line includes 14 characters, including punctuation and spaces on each line. (Do not exceed 14 total characters including spaces and punctuation.) *
Your answer
Line #2 Each line includes 14 characters, including punctuation and spaces on each line. (Do not exceed 14 total characters including spaces and punctuation.)
Your answer
Line #3 Each line includes 14 characters, including punctuation and spaces on each line. (Do not exceed 14 total characters including spaces and punctuation.)
Your answer
Graphic (add additional $5.00 to price) *
Please note that we are unable to place an order for your Brick(s) until payment has been received via PayPal on the Brief Encounters website. We will verify payments with the order forms as they come in. If you have any questions, please contact Laura Klyzek at 503-699-8006. Your call will be returned within 48 hours.
Your answer
Bricks are $50.00 each. Bricks with graphics are $55.00 each. Payment should be made on the Brief Encounters website through the PayPal link located at the bottom of the homepage.
Your answer
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