With your donation of $100 or $250, you will have a brick with your inscription placed in our patio. The proceeds from this fundraiser will go towards the developing of our horticulture program and the building of a greenhouse.

Please fill out this printable version of the form below and return to:
Lakeside Curative Services, Inc.
2503 Lincolnwood Court
Racine, WI 53403
Make checks payable to: Lakeside Curative Services, Inc
4” x 8” brick: donation $100
Personalized up to 3 lines of 14 characters each line
8” x 16” brick: donation $250
Personalized up to 6 lines of 28 characters each line
Name: _________________________________________
Address: _______________________________________
Phone: _________________________________________
Please include your inscription to be placed on the brick.
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