History Walk of Fame

History Walk of Fame
For $100 you can honor someone with a brick inscribed with the name of someone special that will be added to the patio at the State Office.
History Walk of Fame ($100.00 per Certificate and Brick)
Make sure the information you provide is complete and accurate for the printing of the brick.
In Honor/In Memory Of:
First Name of Honoree
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Last Name of Honoree
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Email of Honoree
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Email of Recipient (enter none if in memory of deceased)

Recipient Street Address
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City of Recipient
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State of Recipient
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Zip Code of Recipient
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County of Recipient
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Honored By
Please type your full name.

(Example: A PTA or a person honoring someone else)

Presentation Date

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Certificate should be mailed to:
First Name of Applicant
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Last Name of Applicant
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Email of Applicant
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Street Address of Applicant
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City of Applicant
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State of Applicant
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Zip Code of Applicant
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Applicant Phone Number
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You must mail your payment immediately upon completion of this application. Enter the date you are processing this application and mailing payment. MAIL TO: Florida PTA, 1747 Orlando Central Parkway, Orlando, FL 32809
MAIL DATE(*)

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BRICK WORDING
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Brick Wording: (Only allowed 39 characters, including spaces)

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