Expression of Interest Bench Dedication Program
Your Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dedication Time Period Requested
5 Years
Lifetime
5 Year Renewal
What type of structure are you wishing to place a plaque on?
Bench
Picnic Table
Who are you dedicating this bench or picnic table to?
Payment Options
Through the website - card
Over the phone - credit card
By cheque - mail
By cheque - Drop off at the Sanctuary
Submit
Should be Empty: