Souvenir Journal Advertising Form

The Square Club of

HIRAM LODGE NO. 5

143 Warwick Rd. Lawnside, NJ 08045

(Please Clearly Print or Type Your Message)  

Attach information on a separate sheet of paper in needed

   ___ Full Page w/ photo   $45.00                 ___  Half Page .............   $30.00

   ___ Full Page .............    $40.00                  ___  Quarter Page .......    $20.00 

Name: _____________________________________________________________

Lodge/Chapter/Etc.: ______________________________________

Address: ___________________________________________________________

City: ___________________________ State: _________ Zip Code: ___________

Phone #: _____________________ E-mail: _______________________________