Become a part of a lasting tribute to the Free Medical Clinic of Greater Cleveland by purchasing a personalized paver brick for our new facility. These epoxy-filled engraved pavers will be added to the front entrance walkway of The Free Clinic as a permanent recognition of your sponsorship. Cost of Engraved Paver |
Purchaser’s Name: | |
Street Address: | |
City, State, Zip: | |
Phone: | |
Fax: | |
Email: |
3 LINES, 14 CHARACTERS PER LINE
(including punctuation and spaces)
Payment Amount $________________________________
Visa ( ) | MasterCard ( ) | American Express ( ) |
Card# __________________________________________________ Expiration Date __________ / __________
Check or Money Order Enclosed ( )
Make payable to:
The Free Clinic of Greater Cleveland
12201 Euclid Avenue
Cleveland, OH 44106
Attention: Development Office
For Office Use Only Date Received __/__/__ Brick Number ______ |
© The Free Medical Clinic of Greater Cleveland