School of Pharmacy UNIVERSITY OF WISCONSIN - MADISON Legacy Brick Order Form Continuing to Build the Legacy: Brick by Brick The School of Pharmacy’s Legacy Walk offers a unique opportunity to show your support for the school while making your memories a lasting part of the landscape at Rennebohm Hall. A personalized, commemorative brick will become part of the front walk of the building, and your donation will help to build the school’s legacy by supporting the Pharmacy Alumni Association Scholarship Fund. There are many personal ways to give back to the school: Commemorate your graduation Memorialize a friend, family member, or faculty member Honor a graduate Celebrate outstanding achievements Leave inspiration for current students Last year the PAA awarded over $25,000 in scholarships to deserving students. For tax purposes, the entire purchase price of $150 is considered a contribution to a non-profit organization. Bricks will be installed near the front entrance outside Rennebohm Hall twice per year, in late Spring and late Fall. You will be notified by email when your brick has been installed. To purchase a Legacy brick, please fill out the form below. Once your form has been submitted, please print out a copy of the confirmation email message you receive and mail it with your check to the address below. Orders received by March 1 with be installed in May of that calendar year. Orders received by September 1 will be installed in November of that calendar year. Send your check to: Pharmacy Alumni Association Legacy Brick c/o UW School of Pharmacy 777 Highland Ave. Madison, WI 53705 Questions? Contact Tyler Liebenstein Pharmacy Alumni Association Treasurer firstname.lastname@example.org Brick Order Form Your Contact InformationName* First Last Email* PhoneI wish to:*purchase a Legacy Brick for myselfpurchase a Legacy Brick as a giftBrick InformationCost: $150 Specifications: Three lines per brick, 14 characters per line maximum including spaces and punctuation. LINE 1:Leave a space between first and last namesLINE 2:Can be used for long names or 2nd namesLINE 3:Can be used for degree and year After submitting your order, you will receive a confirmation email shortly with instructions on where to send your $150 payment.