Memorial Application Form

Application for a dedicated memorial bench, tree or shrub

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Please read the Memorial Benches, Trees & Shrubs Policy before completing this form. It can be viewed at: https://www.thametowncouncil.gov.uk/wp-content/uploads/2022/11/Memorial-Benches-Trees-Shrubs-30.8.22-1.pdf

Date of Application(Required)

Please notify us of any change of name or address so we can contact you if we need to.

Name(Required)

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Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone

Name of person for dedication:(Required)

Reason for dedication:(Required)

Preferred location:(Required)

Second choice location:

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