Please complete this form and mail or return to the Church Office with your check as soon as

possible to ensure your choice of dates.

Little Chapel on the Boardwalk

2 West Fayetteville Street

Wrightsville Beach, NC 28480

For each Sunday you request, please enclose your check for $50.00 (per vase that you choose to fill) payable to the Little Chapel on the Boardwalk. 

Be sure to mark it “Flower Fund.”

Amount Enclosed _________________________________________

Your Name ______________________________________________

Your Address ____________________________________________

________________________________________________________

Your Telephone Number ___________________________________

In Loving Memory of ______________________________________

________________________________________________________

OR

In Honor of ______________________________________________

                                    (State relationship or occasion, if appropriate)

__________________________________________________________________

Disposition:

  (Check one):  I would like to have the flowers  __________

                                Deliver to ill/bereaved/nursing home  __________

  Choice of Dates:  First _______________  Second _______________ 

                                           Third _______________  No preference _______________

(Almost all Sundays from November 9, 2008, to October 25, 2009,

are available except December 14, 21, and 28, 2008,

when we will use poinsettias, and April 12, 2009, when we will use Easter lilies.)