Fairfield 12th Man Club

Press box Paver form

The 12th Man Club would like to give you the opportunity to
purchase an engraved block for everyone to see. Purchase a block
in memorial of a loved one, honor a former/current Fairfield
student athlete or band member, advertise your business or buy
one with your family name. The possibilities are endless!
Make checks payable to:
Fairfield 12th Man Club
c/o Andy Brock
13271 CR 44
Millersburg, IN 46543
4 x 8 Brick: $50.00 each

8 x 8 Brick:
$100.00 each

Fairfield 12th Man Booster Club Paving Brick Order Form:

Name:________________________________
Address:_____________________________________________________
Phone:______________________________________________________
Email address:________________________________________________
________ X $100.00 ( 8 x 8 Bricks) = $____________
________ X $50.00 ( 4 x 8 Bricks) = $_____________
Inscription for 8x8 Brick(s): $100.00 each
No more than 16 characters, spaces or punctuation per line. J&N Stone has the
right to modify or change as needed to fit brick if over 16 spaces.
First Line: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
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Inscription for 4x8 Brick(s): $50.00 each
No more than 16 characters, spaces or punctuation per line. J&N Stone has the
right to modify or change as needed to fit brick if over 16 spaces.
First Line: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Second: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Third: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

*Note: Please fill out additional forms for each brick that you wish to purchase.