Print from your browser and mail to:
Old Songs, Inc.
 BUY A SONG BRICK!
Capital Fund Drive for 37 South Main St.
E-mail: oldsongs@oldsongs.org

Old Songs, Inc.
PO Box 466
Voorheesville, NY
12186-0466

or fax charges to:
(518) 765-4248

Fill in grid with your song title. There is a maximum of 3 lines, 14 characters per line, including spaces.
Bricks are 4" x 8".

Author/Source:_______________________________________

2nd choice: __________________________________________

Please select songs that fit generally in the folk/traditional genre. The bricks will contain song titles only, but a “map” of the sidewalk will be displayed in the building with donor names, dedications, etc. In order to avoid duplication, titles are subject to approval by the Old Songs Board of Directors.

Is there a story behind your song choice? Let us know.

Dedication, if any:

Home Address: (Please print)

Name_________________________________________________

Address:_______________________________________________

City:____________________________State_____ZIP___________

Phone: _______________________________________________

E-mail:________________________________________________
             (for early news of events)

____Enclosed is my gift
of $50
Enclose check or money order made out to Old Songs, Inc.

____Please charge my contribution of $50
Supply credit card information below.

More than one brick?
Please fill out a form for each brick you'd like inscribed.
CREDIT CARD INFORMATION:     Mastercard____   VISA____

Card No:   __  __  __  __      __  __  __  __      __  __  __  __       __  __  __  __            Exp Date:  ____ /____                 

Cardholder's Signature 

All donations are tax deductible to the extent of the law