Person Details: Please Note that * Denotes Required Field! First Name* : Last Name* : Home Phone* : Cell Phone :   Email* :       Street* : City* :   State : Zip Code :   Enter number of Bricks to sponsor (One Brick $5,001)   x $ 5,001 Total $ Note: You may sign-up for full amount now and pay by 2020. Check Number : Check Date :     (Please send the Check) (Please make your check payable to Quad City Hindu Temple)