Labyrinth Brick Form
If you are interested in purchasing a brick to be placed in the St. Francis Springs Labyrinth, please fill out the form below. Once you complete it, someone will email you to collect payment. Bricks are $100 each. 
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Purchaser's name (Last, First Name) *
Purchaser's email address *
Purchaser's phone number *
Chose from the following: *
Last Name of Honoree or Memorial
Ex: Jones
 *
First Name of Honoree or Memorial 
Ex: Claire
 *
Full Name of Honoree or Memorial on Brick
(This line of the brick can only have 20 characters; including letters, symbols and spaces)
Ex: Claire Jones
 *
Given by (Person, Family, Organization, etc.)
(This line of the brick can only have 20 characters; including letters, symbols and spaces)
Ex: The Barton Family
Ex: Salvation Army
*
Select a method of payment.

A. Send a $100 check to St. Francis Springs Prayer Center 
St. Francis Springs Prayer Center
ATTN: Labyrinth Bricks 
477 Grogan Rd Stoneville, NC 27408 

B. Pay online 
 *
Notes or Questions
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