Apply for a memorial bench or plaque

Your name

Your phone number

Address Line 1

Address Line 2 (Optional)

City/Town

County

Postcode

Your email addres

Do you want a new bench and plaque installed in a park, or just a plaque on a bench which is already in one of our sites?

A new bench and plaque

A plaque on an existing bench already in a park

Name of proposed location for bench and/or plaque

Please enter the proposed inscription, with a maximum of 72 characters including spaces

If you would like to upload an image showing how you want your inscription to look, or an image of a person or feature, you can do so here. Files, in gif jpg jpeg png format are acceptable (Optional)

One file only.
128 MB limit.
Allowed types: gif, jpg, jpeg, png.

Additional information, e.g. if you are looking at a site or bench type not already listed (Optional)