Please fill in your contact information below:
Note:  Do NOT hit [Enter] until you are ready to submit this form.  To quickly go from box to box, use the [Tab] key.

Name

Company

Address1

Address2 (if needed)

City/State/Zip

Phone (daytime)

Phone (evening)

Phone (cell)

e-Mail Address

Pavers for the Honorary & Memorial Garden Walkway are $ 100.00 each.  NOTE:  These pavers will be placed at the garden and walkway borders and not in the walking area.  For additional information, you are welcome to call (740) 397-5188 between 9:00 a.m. and 4:00 p.m. Monday through Friday.

Type in the box below the personalization for the paver.
You may personalize up to three (3) lines each with a maximum of 18 letters including spaces.  It will be engraved exactly as it appears below, so be sure to check spelling and spacing for accuracy.  

I request this paver be placed in the
          Honorary & Memorial Garden & Walkway, $ 100.00

These pavers will be routinely placed throughout the year.

When you click Submit, your paver order will be sent to Hospice of Knox County and you will receive a Confirmation page; you may wish to print it for your records.  On that Confirmation page you will have the option to make your payment online if you so desire.  Of course, you may send your gift by mail.