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Commemorative Brick Form
Bricks Can Be Ordered 365 Days A Year

Our Commemorative
Bricks Surround The Base
Of Our Memorial



Cost Of A Brick:  $ 30

14 Characters Per Line
3 Lines


This Includes Spaces
And Periods Per Line

Please Mail Form To:

Vietnam Veterans
Of America
Chapter  649
P. O. Box 426
Batavia,  Ohio
45103

Please Allow 30 / 60
Days For Engraving
And Placement Of
Your Brick

Shown Below Are Samples Of The Many Commemorative Bricks In Place At Our Memorial
Jack Haigwood
U.S.N. Seabee
Vietnam  66 - 68
James Crump
U. S. Navy
Vietnam
Tom Hesler
U. S.M.C.
1960 - 1969
Stephen Tam
U.S. Army
1968 - 1969
George Kinniard
U. S. Airforce
1964 - 1968 
James A. Arnold
U. S. Army
1966 - 1968 
Jim Smith
173rd Airborn 1968 - 1969
God Bless Vets
UAW Local 863
Veterans Comm.
Edyth And Carl
Linder
May 17 2007
Amelia High
Salutes All
Veterans
F.O.P. Lodge 112
Eastegate
Womens  Club
D. A. V.
Chapter  63
Batavia  Ohio
The Lessons Of
Vietnam Gifted
Class 1997 - 1998
Union Township
Trustees
Thank You
Most of Chapter 649 Forms Are Formated As PDF Forms,
Allowing  You To  " Fill - In"  From Your PC
Once Fillled In, You May Print-Out,  /  Save As  /  Or Just Print - Out and Fill - In By Hand
* Please Consider Filling - In from your Computer, allowing all words to be Legible
* PLEASE  REMEMBER TO:  FILL- IN  ALL  SHADED  AREAS
This will allow Chapter 649 To contact you, should questions Arise
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