Welcome to the Unified Committee for African American Contributions (UCAC)

BUY-A-BRICK ONLINE ORDER FORM

Individuals and organizations wishing to provide financial support for the monument's maintenance and future improvements may purchase bricks for $50 each using the printer friendly order form, or by using the Online Buy-A-Brick Order Form.

These bricks will be placed on the walkway surrounding and leading to the monument and will serve as a permanent acknowledgement of the donor's support and commitment to the importance of African-American contributions to St. Mary's County.

UCAC is now able to offer online payments through PayPal. You won't need to setup a PayPal account.  PayPal allows credit card payments without creating an account.

  • By applying online, you agree to pay in full immediately after submitting this form. 
    (If you prefer to mail in a paper copy and a check, please download, print and mail in the paper application.)
     
  • After completing all fields, click the “Submit & Proceed to Online Payment” button at the bottom of the page.
     
  • You will then receive payment instruction on the following page.
     
  • Please fill out all available fields. The form cannot be submitted unless all fields are completed.
  • Important: The $50 price per brick includes 18 free characters.
    If you require additional characters, there will be an additional charge.
    Please see cost chart at right >>
BRICK COST CHART
 $50.00: 18 or Fewer Characters
 $51.00: 19-20 Characters
 $52.00: 21-22 Characters
 $53.00: 23-24 Characters
 $54.00: 25-26 Characters
 $55.00: 27-28 Characters
 $56.00: 29-30 Characters
 $57.00: 31-32 Characters
 $58.00: 33-34 Characters
 $65.00: 35-48 Characters

First Name:

Last Name:

Address:

Telephone:
 

City:

State

Zip Code
 
    
Email Address:
    
Please type name(s) as it is to appear on your brick
(See above photo for examples of wording.)
Line 1:
 
Line 2:
 
Line 3:
 
    
I will pay the full amount online. (You will be directed to online payment page after completion of registration.)
    


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