There are two forms on this page.  The first form is for the flag dedication, and the second form is for payment Information.

First, please fill out the “Field Of Honor Individual Flag Order” form.  When the information is completed, please click the “Submit Dedication” button.

Secondly, fill out the “Payment” form.  When the information is completed, please click the “Submit Payment Information”.

In addition to submitting the dedication and the payment information, in order to pay by credit card please use the links on this page to the secure checkout using Square.

Flag dedications are $40 each. Please email exchangeclubnewburyport@gmail.com with any questions.

Field Of Honor Individual Flag Order

Field Of Honor Individual Flag Order

First Name *

Last Name *

Email Address *

We'll never share your email with anyone else. If you don't have an Email Address, please use your phone number.

Street *

Street Number, Name, and Apt #

City *

State *

Two characters

Zip *

##### or #####-###

Tag Information:

Flag Dedication and Donor Message

The message may contain up to about 20 words.

Please select: *

I will pick up my flag on September 15th.

I would like to donate my flag to The Exchange Club to be used for future events.

Dedicated By

Dedicated By

First Name

First Name

Last Name

Last Name

Submit Dedication

If you are human, leave this field blank.

Δ