Please download and complete this form before purchase. Once transaction is completed please send it to orders@diabetes.ca with your order number in the subject line.

Write yourself into the story of the birthplace of insulin!

Thanks to Dr. Frederick Banting, insulin has been saving lives for more than 100 years.
You can build upon the work of Banting and the Toronto team, by purchasing a personalized, commemorative brick at Banting House National Historic Site of Canada. 

Personalize your brick to:

• pay tribute to a friend, family member, a beloved pet, or yourself
• preserve a legacy
• acknowledge a diaversary
• memorialize a loved one

Please note:

• Purchase of brick is eligible for a charitable receipt
• Refer to page 2 of the pdf for a guide on character and space limits for the grids.
• Feel free to use symbols and abbreviations as needed. If you need assistance with wording, please contact us at banting@diabetes.ca
• The brick will be officially installed and unveiled in the Sir Frederick G. Banting Square on Thursday, November 14, 2024, as part of our World Diabetes Day│Banting’s Birthday celebration