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Penn State Harrisburg celebrates its 40th anniversary this year. You can become a visible and permanent part of its history by having your name, the name of a loved one, or your company engraved on a brick to be placed in the new Ziegler Commons. Each personalized brick costs $150 and there is a maximum of three lines with 14 characters each. Just print this page, fill out the form, and return it to the Development Office to reserve your brick.
____________________________________________________________________________________
Name
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Address
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City State Zip
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Phone Email
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Number of Bricks
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Line 1
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Line 2
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Line 3 or Nittany Lion Image
$___________________________________________________________________________________
Amout of Payment (Payments can be made by check, money order, or credit card. Your donation is tax deductible.)
(Make checks payable to The Pennsylvania State University)Charge to: _____ MasterCard _____ Visa _____Discover _____ American Express
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Account Number
____________________________________________________________________________________
Expiration Date
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Cardholder's Name (Please print as it appears on card.)
____________________________________________________________________________________
Signature
For More Information Contact:
Development Office, Penn State HarrisburgW-110 Olmsted Building
777 West Harrisburg Pike
Middletown, PA 17057-4898
Phone: 717-948-6316
Fax: 717-948-6317