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DUBLIN SENIOR FOUNDATION DONOR WALL Two Donor Walls are located in the Main Hallway nearest the Ballroom. PLAQUE ORDER FORM Payor’s First Name: Last Name: Address: City: State: Zip Code: Phone Number: E-Mail: SAMPLE I N M E M O R Y O F J O E D U B L I N 2 ½” x 5 ½” ($250; 16 spaces & characters per line a ¼” tall each; 2 lines) 2 ½” x 12” ($1,000; 16 spaces & characters per line a ½” tall each; 2 lines) 6” x 12” ($2,500; 16 spaces & characters per line a ½” tall each; 3 lines) 12” x 12” ($5,000; 16 spaces & characters per line a ½” tall each; 6 lines plus custom logo) Amount Paid: Date: Date Installed: Initial: Plaques will be installed from top to bottom in the order received. Spaces cannot be requested. Please return completed form to the Dublin Senior Center Receptionist Desk. Checks may be made payable to the Dublin Senior Center Foundation. For more information, contact George Zika on Wednesdays from 9:00 AM to 12:00 PM. ---PAGE BREAK--- The foundation is now accepting requests to purchase a plaque for the Dublin Senior Center Foundation Donor Wall. There are FOUR levels of giving. The accumulative giving levels are as follows: Benefactor: $5,000: 12” x 12” Sponsor: $2,500: 6” x 12” Donor: $1,000: 2 ½” x 12” Individual: $250: 2 ½” x 5 ½” Please return a completed application form and check made payable to the Dublin Senior Foundation to the receptionist desk.