Yellow Brick Road Form for $125 Brick If you are a human and are seeing this field, please leave it blank. YOUR CONTACT INFO Fields marked with an * are required First Name * Last Name * Email * Phone * YOUR BRICK INSCRIPTION Fields marked with an * are required Type in the text (inscriptions) you wish to have on your brick. Your brick can have from 1 to 3 lines of text. They will be centered vertically when the brick gets made, even if you only use 1 or 2 lines. Do not add extra spaces on the left or right of your text. Text will also be centered horizontally for each line. Please make sure you type EXACTLY what you want engraved in your brick! We cannot be held responsible for spelling errors or typos. Inscription Line 1 * Inscription Line 2 Inscription Line 3 BRICK PRICE & DISCLAIMER Fields marked with an * are required Brick Price * Additional Donation (optional) Total Donation May we share your name and donation amount with other Villagers patrons? * YesNo BRICK ORDER DISCLAIMER: In the event that the Yellow Brick Road cannot be constructed, your donation will be returned less the nominal fee that is charged by the credit card (or other processing) company to complete the transaction. Please review your requested inscription carefully. Engraving will be done as submitted and Villagers Theatre cannot be responsible for spelling errors or other mistakes in the submitted request. All submissions will be engraved, however, Villagers Theatre reserves the right to NOT install any brick that has been engraved with anything inappropriate, pornographic, or considered to be not in the spirit of the project. Donations for rejected bricks will not be refunded. If rejected, the donor for that brick will be notified and the engraved brick will be available for pickup at the theater for a period of 30 days after the notification. THANK YOU FOR YOUR SUPPORT! Thank you so much for your donation to Villagers Theatre. After clicking Confirm Order below, please wait till processing is complete. Please do NOT hit your browser's BACK button or close your web browser until prompted to do so, or your order may be lost. We are a 501(c)3 non-profit and a NJ charitable organization (search for “Villagers”). All donations are tax deductible.