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.

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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

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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

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Expiration Date

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Cardholder's Name (Please print as it appears on card.)

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Signature

For More Information Contact:

Development Office, Penn State Harrisburg
W-110 Olmsted Building
777 West Harrisburg Pike
Middletown, PA 17057-4898
Phone: 717-948-6316
Fax: 717-948-6317