Reflection Garden 4 x 8 Brick

You may order your Surgery Center Reflection Garden Brick  for $100 each by using this secure form. The process is secure, and donations can be made in just a few minutes. Each 4 x 8 brick can accomodate up to three lines, 18 characters on each line (including spaces and commas.) We also can send notification to someone about the honor. We also have a limited number of 8 x 8 bricks as well for $250 each. Click here if you are interested in an 8 x 8 brick If you have questions, please contact us at 3173-346-3703 or email us at foundationmail@johnsonmemorial.org.


DONOR INFORMATION
Please provide your information for contact purposes and to order your brick. Each brick requires a new order.

Your First Name
Your Last Name
Your Email Address
Your Street Address
Your City
Your State
Your Zip
Your Daytime Telephone

DONOR PAYMENT
Please provide your credit card payment information to order your brick. Each brick requires a new order.

Name on Credit Card
Type of Credit Card
Credit Card Number
Expiration Date

BRICK MESSAGE

Please provide the inscription for your brick. The maximum number of characters is 18, including commas and spaces. You can include up to three lines. For example:

                           In Honor of
                        Joe and Mary
                            Johnson

Line 1 (maximum 18 characters including spaces, commas)
Line 2 (maximum 18 characters including spaces, commas)
Line 3 (maximum 18 characters including spaces, commas)

NOTIFICATION OF GIFT

If you would like the Foundation to send a notification of your gift, please fill out the following:

Name of Person(s) to be Notified
Street Address
City
State
Zip
 

Through the Foundation, we give back to a hospital that has given so much to our health.

Doug Stewart

JMH Foundation Board President

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