Your brick purchase directly benefits patient care at Scottish Rite Hospital. Each brick has up to two lines available and a maximum of 18 characters (including spaces) per line. Leave a space between names and before and after "&".
If you would like an acknowledgment of your brick sent, please enter the full name and mailing address for each brick purchased. Be sure to indicate which acknowledgee applies to which brick in the Comments section of the form. For example, 'Brick 1: John Doe, 123 Anywhere St., Anytown, ST 12345'
If you prefer, you can download the Printable Engraved Brick Order Form.