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Name of donator or organization
Phone
Email
Addressincluding postal code
Name of individual proposed for memorialization
Proposed wording for plaque
Type --- Please select --- Bench Tree Plaque Only
# Year term --- Please select --- 5 10 15 20
Location --- Please select --- Map (attach) Photos (attach)
Upload documents (max 7 MB total)
Written consent Family Executor
All payments processed at the Parks Department, 23 East Lake Hill, Airdrie, AB 403.948.8400
Enter the item quantity
Fees Subject to GST
Name
Date
Signature I acknowledge that [by displaying/typing my name above], I am signing this application, and I agree to be bound as if I had endorsed this document with my own handwritten signature.
The information on this form is collected under the authority of Section 33(c) of the Freedom of Information and Protection of Privacy Act ("the Act") and will be used solely for administering the Memorial Policy. It will be treated in accordance with the privacy protection provisions of Part 2 of the Act.Questions concerning collection of this information can be directed to Parks Department at 23 East Lake Hill NE, Airdrie, Alberta T4A 2K3 or at 403.948.8400.