Required fields are marked with asterisks (*)

Memorial Bench Program Application

Applications received between September 1st and March 31st will be processed in April, and benches will be installed in the summer. Applications received between April 1st and August 31st will undergo processing in September, and benches will be installed in the fall.

NOTE: We will only process the application once the donation has been received.

Donor Name

Email:

Phone Number:

Address:

City:

Province:

Postal Code:

Text to be displayed on plaque: (Note: Maximum 70 characters including spaces, maximum 3 lines. Text will be duplicated exactly as provided, including upper & lower case)

Location of Memorial bench, Please be specific

If you have a photo or screen shot of where you would like the bench to be located please upload it here.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Charitable tax receipt

Yes

NOTE: After you submit your application please be sure to make your payment at Town hall in order for your application to be processes.

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Memorial Bench Program Application