Memorial Application Form

Application for a dedicated memorial bench, tree or shrub

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)

Applicant Details

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

Name(Required)

First Last

Address

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

Phone

The Application

Name of person for dedication:(Required)

Reason for dedication:(Required)

Preferred location:(Required)

Second choice location:

Privacy Notice(Required)

Thame Town Council regards your privacy as important and any personal information you give to use will be used in accordance with the law. Please read our privacy notice at www.thametowncouncil.gov.uk/privacy
By ticking the box below, you are agreeing that Thame Town Council can hold and process your personal data, as provided on and with this Form.

I agree to the privacy policy.

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Name

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