Personal Brick Information

Only two lines of information will be accepted on each brick 

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* 1. First Line: (Max 13 Characters Including Spaces)

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* 2. Second Line: (Max 13 Characters Including Spaces)

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* 3. Third Line: (Max 13 Characters Including Spaces)

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* 4. Name of GoFundMe Donor(So we can verify donation of $100)

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* 5. Contact Phone Number

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* 6. Donation Amount