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2. 2026 Brick Campaign

   VETERAN’S PATIO WWII MEMORIAL BRICK APPLICATION

   
   Bricks sold through May 1, 2026

   
   If you prefer a written application please download this form.

4. Please complete one form for each brick ordered, and mail with your payment of $100 per brick.   
   
   Make checks payable to: Calvert County Treasurer
   Write on the memo line: WWII Memorial Brick
   
   Mail to:
   Carter Burchinal
   Department of General Services
   County Administration Building, 150 Main Street
   Prince Frederick, MD 20678

6. Brick is for

   1. Self
   2. Relative
   3. Friend
8. Your first name
9. Your last name
11. Address
13. City
14. State
15. Zip code
17. Email address
18. Phone number
20. Memorial brick commemorating the military service of:
22. Is this commemoration for someone who is living or deceased?

    1. Living
    2. Deceased

24. Information to be engraved on brick (please print clearly using ALL CAPITAL LETTERS)

    Line 1	Rank and name:	SGT JAMES FISCHER	(examples)	JAMES FISCHER
    Line 2	Branch of Service:	US ARMY	or	SGT – US ARMY
    Line 3	Years of service:		1941-1945

    
    Each character counts as a space, limit 18 characters per line. Please use all capital letters. Information will be centered. Do not use a space for punctuation, but do use one for separation between words.

26. Line 1 text
28. Line 2 text
30. Line 3 text
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field