OCSL Chair Dedication

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Name

*

Phone

Email

*

This address will receive a confirmation email

This is an opportunity to provide a plate dedicated to individuals, organizations, or families on the back of our chairs.

The cost of chairs can be shared by more than one person. If applicable, please provide the name(s) below

Please indicate your plate preference.

*

Please select one option.

Bronze $50 (2 lines max - 33 total characters) Silver $100 (3 lines max - 47 total characters) Gold $200 (4 lines max - 87 total characters) Platinum $500 (5 lines max - 105 total characters)

Please provide your inscription below as you would like it to appear

It's important to provide accuracy of the inscription as it will be printed exactly as you state. Please review and check the box below verifying your information is accurate.

*

Please select all that apply.

Yes.. The information is correct

I would like to make an additional donation

Method of Payment (cash or credit card)

Cash Bronze ($50) Silver ($100) Gold ($200) Platinum ($500)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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Please Fix the Following

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