Light the Light Order Form
(to dedicate the light one night)

Click anywhere on this page and then print form.

Your Name:

Your Address:

City / State / Zip

Home Tel:

Work Tel:

Email:

Fax:
1. DATE: Please light the Rose Island Light on the night of:   ___________________________

2. DEDICATION (See sample wording below)
__ in honor of
__ in memory of
__ to celebrate the marriage of
__ to celebrate the graduation of
__ to celebrate the arrival of
__ to celebrate the birthday of
__ to celebrate the life of
__ to honor the work of
__ Other as follows: _______________________

 

3. NAME(s) TO BE HONORED:

_____________________________

_____________________________

4. GIVEN BY:

 ______________________________

 

______________________________

 

MAIL ACKNOWLEDGMENT CARD TO:     __ Me at the address above OR to:

Name:

Address

City, State, Zip
PAYMENT:   $100   ___ Check       ___ Money Order  ___ Travelers Check

       __ Visa/MC _____________________________ Exp. Date: ___/___

      _______________________________________  
            Signature

Click anywhere on this page and then print form. Mail or Fax with payment information.

Rose Island Lighthouse Foundation
P.O. Box 1419, Newport, RI 02840
Phone: 401-847-4242     Fax: 401-847-7262


Sample wording of acknowledgement cards:

Advance notice:

This is to inform you that on the night of (1. Date) the Rose Island Light will be lit (2. Dedication) (3. Honored Person's name), by (4. Given By) and will be entered into the Keeper's Log on that date.

Belated notice:

This is to inform you that on the night of (1. Date) the Rose Island Light was lit (2. Dedication) (3. Honored Person's name), by (4. Given By) and was entered into the Keeper's Log on that date.