SAMF Wall of Honour Form
Fill out this Secure Online form below

How do I know this page is Secure?

or
You may Fax us at
902-461-1610, OR
Phone toll-free to 1-888 497-7779
Local: 461-0062


Email:
Name:
Address:
City:
Province / State:
Postal / Zip Code:  
Phone Number:
Fax Number:

Tile Option:

Option A
$300

Option B
$600

Option C or D
$600
Please select option:  

I am paying by:
Card Number:
Expiry Date: Month    Year
ENGRAVING  REQUEST
The colour of the tile will be ‘Belmont Rose’.  If the
submission requires any alteration, the subscriber will
be contacted by phone or email by the coordinator for
 further discussion.  REMEMBER TO COUNT THE SPACES!
Tile Description:
Describe your engraving details in the space below.
Count the lettering for each line as described in our cover page.
Please check accuracy before sending - we are not responsible for any misspelled words.
We will contact you on receipt and review of your order.


Please check engraving details for accuracy before sending. 
We cannot be responsible for misspelled words on your order form.

For further information, please call the SAMF Secretary: Toll Free: 1-888-497-7779 of (902) 461-0062Fax (902) 461-1610  
Email: samfoundation@sympatico.ca                





For further information, please contact the SAM Secretary.