Revised as of 5/30/2008

Name:
Company:
Address:
Phone:
E-mail:
	New order    or   Revised order
	Please choice your sponsoring method. If you are purchasing a Legacy Brick, please make sure your message fits within the brick limits. Spaces and Symbols are counted as part of the line limit.
	Legacy Bricks   4” by 8”         3 lines/14 characters per line $100.00 8” by 8”         6 lines/14 characters per line $250.00 20” by 20”         18 lines/35 characters per line $1500.00
Message:	Line 1:   characters left Line 2:   characters left Line 3:   characters left Line 4:   characters left Line 5:   characters left Line 6:   characters left Line 7:   characters left Line 8:   characters left Line 9:   characters left Line 10: characters left Line 11: characters left Line 12: characters left Line 13: characters left Line 14: characters left Line 15: characters left Line 16: characters left Line 17: characters left Line 18: characters left
	Please print this page BEFORE you submit. After submitting your order, please ADDRESS your payment to: Seabreeze Centennial Fund and SEND your payment and a copy of this order form to: Prosperity Bank, Attn: Legacy Crabwalk 1259 W Granada Blvd, Suite 1A, Ormond Beach, FL 32174
	By submitting this order, I agree to pay the amount of the sponsorship method selected above.

You will be contacted for inscription message verification.

Contact: Ruthie Labno, rlabno@volusia.k12.fl.us
Don't forget to get your Centennial Yearbook!