STANDIN' ON A CORNER IN WINSLOW, ARIZONA 

PARK PROJECT ORDER FORM_____________________________________________________________________
Please Print Clearly:

Using only 15 characters per line with 3 lines for a 4 x 8 brick, 
6 lines on the 8 x 8 brick, and 10 lines on the 12 x 12 brick.

BRICK SIZE:                    
                    4” x 8”     $50 Donation           

                    8” x 8”     $100 Donation
                    
                    12” x 12”   $250 Donation 


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Donor___________________________________________

Address_________________________________________

City/State____________________________Zip_______

Telephone_______________________________________


Mail to:  La Posada Foundation, Inc.
          P. O. Box One
          Winslow, Arizona   86047-0001  



*************************** Thank You *****************************