1. Print out this form, fill out by hand and mail. We are unable to accept orders on-line.

You can preview your brick design in "Flash" – see bottom of page!

2. Information for my brick

Athlete Name (use line 2 only if name is too long for line 1)

Hometown

3. For Follow-Up Communication

First Name	Last Name	Date
Address
City	State	ZIP
Phone	Email
Amount Enclosed (bricks are $100 minimum)

4. Payment
Please make checks payable to Special Olympics Illinois. Mail check(s) with this completed form to Tribute Park, Special Olympics Illinois, 605 E. Willow, Normal, IL 61761.

If you have questions, or need additional information, contact soill@soill.org or call Special Olympics Illinois at 800-394-0562.

5. If you would like to ask people to help you raise money for your brick, please have them fill in the information requested below (if you need more lines, please use the back of the paper). Mail all checks together with this form.

ATHLETE SPONSOR FORM (checks payable to Special Olympics Illinois)

Sponsor's Name	Address, City, State, ZIP		Donation

6. You can Preview Your Engraving using "Flash."

7. Remember, to actually place your order, print out this form, fill out by hand and mail . Include check(s) and Sponsor Form if you have sponsors.

Special Olympics Illinois Home Page

Volunteer Opportunities

Major Park Donors

Contact Special Olympics Illinois