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Willing Hearts Memorial Garden Brick Order Form

The Willing Hearts and the KDMC Foundation are proud to offer a lasting memorial for your loved ones. By completing the information below and including your payment, you ensure that someone special to you is remembered for a long time to come. We will be offering the option of memorial bricks and memorial benches. Benches and bricks may also be purchased in honor of a living loved one.

Memorial bricks: $125

Each brick can hold two lines of characters with a limit of 14 characters per line. All inscriptions are in capital letters. Spaces between words count as 1 character. Please complete the information below for your order.

Willing Hearts Memorial Garden Order Form
Address
Address
City
State/Province
Zip/Postal
14 character limit
14 character limit
14 character limit
14 character limit

Press the "Click here to pay" button below to begin the payment process.

Important! Please enter the code: memorialbrick (all one word) in the "KDMC Patient Account Number" field on the next page.