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Buy a Brick for a New Generation
Relive Today’s Joy Forever
MidState has created a special “New Generation” engraved brick as a
way for you to commemorate your family’s newest addition. With a
contribution of $250 to MidState Medical Center, this unique brick will
feature your child’s name, date of birth and teddy bear artwork. The
brick will be placed in the Tribute Walkway located on the MidState
Medical Center campus.
This unique brick will be a reminder of a truly joyous occasion
for your family.
On behalf of MidState Medical Center and the Family Birthing Center,
thank you. Please know that your gift will allow us to continue to
provide the finest in “New Generation” healthcare to our community.
To purchase a New Generation Brick, please return the completed
form along with your contribution of $250 to the address below:
MidState Medical Center Development Office
435 Lewis Avenue Meriden, CT 06451
To learn more about the MidState Medical Center Development program,
please contact us:
Email: [email protected]
Telephone: (203) 694-8742
Facsimile: (203) 694-7650
Website: www.midstatemedical.org/donate
$
Cut here and return completed form below with payment to: MidState Medical Center Development Office, 435 Lewis Avenue, Meriden, CT 06451
New Generation Brick Form
Information to appear on brick: (12 characters including spaces per line and up to 3 lines per brick)
Name: _____________________________________________________________________________________________________
First
Middle
Last
Birth Date: ________________________________________________________________________________________________
Month
Day
Year (MM/DD/YY)
q I/We would like to purchase ____ brick(s) at $250 per brick
q I/We do not wish to participate in the New Generation Program at this time, but would like to make a
contribution to the Family Birthing Center.
Name _____________________________________________________________________________________________________
Address ___________________________________________________________________________________________________
City _______________________________________________ State _____________________ Zip _________________________
Phone _____________________________________________ Email _________________________________________________
Enclosed is my/our payment of $ __________
q Cash q Check (Payable to MidState Medical Center)
q Credit Card (MasterCard or Visa accepted)
Card # ___________________________________ Exp. Date ___________
Signature _____________________________________________________
Your tax-deductible contribution will support the MidState Medical Center Family Birthing Center.