Logos Legacy Lane 4"x 8" Brick Paver Order Form

Order your personalized brick on the Logos Public Charter School entrance walkway at 1203 North Ross Lane in Medford, Oregon!  The name(s) of your family, student, business or organization will recognize your legacy in the success of Logos.  Use of the same name is limited to 5 bricks.

2 Ways to Pay!
1. Credit/Debit Card.  Log onto the Logos payment portal at https://logoscharter.com/payments/ citing "Brick order" in the instructions box.
2. Check or Mail Order via mail to Logos Public Charter School, ATTN: Legacy Lane Bricks, 1203 N. Ross Ln., Medford, OR 97501.

**Brick engraving will begin after both this form AND payment have been received.**

NOTE: Logos reserves the right to refuse any brick inscription for offensive, negative, or any other reason deemed by Logos to be inappropriate. Once installed, bricks become property of Logos Public Charter School located at 1203 North Ross Lane, Medford, OR, 97501.  Engraved bricks will be randomly placed throughout the entrance of the school, deemed "Legacy Lane."  Bricks are not returnable or refundable.  Use of the same name is limited to 5 bricks.  For additional information please contact: Melanie Scofield at mscofield@logoscharter.com, (541) 842-1936, or Cassie Zimmerer at czimmerer@logoscharter.com, (541) 842-1934.  Logos Public Charter School is a non-profit 501c3, EIN #27-1643351.  Thank you for your generous support!
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Contact Information
Name: *
Email Address: *
Phone Number: *
Mailing Address (Street): *
Mailing Address (City, State, ZIP): *
Order Details
Brick Examples
Single Engraved Brick, $100
Total $ Amount: *
Method of Payment I am submitting to Logos Public Charter School: *
Brick Inscription
Brick 1 Inscription
You may have a maximum of 4 lines with 25 characters per line including spaces.  The size of your inscription will be adjusted appropriately to the number of lines engraved.
Line 1 Inscription (25 letter/character maximum, including spaces): *
Line 2 Inscription (25 letter/character maximum, including spaces):
Line 3 Inscription (25 letter/character maximum, including spaces):
Line 4 Inscription (25 letter/character maximum, including spaces):
Brick 2
Brick 2 Inscription
You may have a maximum of 4 lines with 25 characters per line including spaces.  The size of your inscription will be adjusted appropriately to the number of lines engraved.
Line 1 Inscription (25 letter/character maximum, including spaces):
Line 2 Inscription (25 letter/character maximum, including spaces):
Line 3 Inscription (25 letter/character maximum, including spaces):
Line 4 Inscription (25 letter/character maximum, including spaces):
Brick 3 Inscription
You may have a maximum of 4 lines with 25 characters per line including spaces.  The size of your inscription will be adjusted appropriately to the number of lines engraved.
Line 1 Inscription (25 letter/character maximum, including spaces):
Line 2 Inscription (25 letter/character maximum, including spaces):
Line 3 Inscription (25 letter/character maximum, including spaces):
Line 4 Inscription (25 letter/character maximum, including spaces):
Brick 4
Brick 4 Inscription
You may have a maximum of 4 lines with 25 characters per line including spaces.  The size of your inscription will be adjusted appropriately to the number of lines engraved.
Line 1 Inscription (25 letter/character maximum, including spaces):
Line 2 Inscription (25 letter/character maximum, including spaces):
Line 3 Inscription (25 letter/character maximum, including spaces):
Line 4 Inscription (25 letter/character maximum, including spaces):
Brick 5
Brick 5 Inscription
You may have a maximum of 4 lines with 25 characters per line including spaces.  The size of your inscription will be adjusted appropriately to the number of lines engraved.
Line 1 Inscription (25 letter/character maximum, including spaces):
Line 2 Inscription (25 letter/character maximum, including spaces):
Line 3 Inscription (25 letter/character maximum, including spaces):
Line 4 Inscription (25 letter/character maximum, including spaces):
Brick 6 Inscription
You may have a maximum of 4 lines with 25 characters per line including spaces.  The size of your inscription will be adjusted appropriately to the number of lines engraved.
Line 1 Inscription (25 letter/character maximum, including spaces):
Line 2 Inscription (25 letter/character maximum, including spaces):
Line 3 Inscription (25 letter/character maximum, including spaces):
Line 4 Inscription (25 letter/character maximum, including spaces):
Brick 7 Inscription
You may have a maximum of 4 lines with 25 characters per line including spaces.  The size of your inscription will be adjusted appropriately to the number of lines engraved.
Line 1 Inscription (25 letter/character maximum, including spaces):
Line 2 Inscription (25 letter/character maximum, including spaces):
Line 3 Inscription (25 letter/character maximum, including spaces):
Line 4 Inscription (25 letter/character maximum, including spaces):
Brick 8 Inscription
You may have a maximum of 4 lines with 25 characters per line including spaces.  The size of your inscription will be adjusted appropriately to the number of lines engraved.
Line 1 Inscription (25 letter/character maximum, including spaces):
Line 2 Inscription (25 letter/character maximum, including spaces):
Line 3 Inscription (25 letter/character maximum, including spaces):
Line 4 Inscription (25 letter/character maximum, including spaces):
Brick 9 Inscription
You may have a maximum of 4 lines with 25 characters per line including spaces.  The size of your inscription will be adjusted appropriately to the number of lines engraved.
Line 1 Inscription (25 letter/character maximum, including spaces):
Line 2 Inscription (25 letter/character maximum, including spaces):
Line 3 Inscription (25 letter/character maximum, including spaces):
Line 4 Inscription (25 letter/character maximum, including spaces):
Brick 10 Inscription
You may have a maximum of 4 lines with 25 characters per line including spaces.  The size of your inscription will be adjusted appropriately to the number of lines engraved.
Line 1 Inscription (25 letter/character maximum, including spaces):
Line 2 Inscription (25 letter/character maximum, including spaces):
Line 3 Inscription (25 letter/character maximum, including spaces):
Line 4 Inscription (25 letter/character maximum, including spaces):
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