Memorial and Tribute Plaques
Inquiry Form
Memorial Choice
*
Please Select
Memorial Plaque at Glen Eden
Memorial Bench
Note: The Conservation Halton Foundation's Memorial Bench program is currently paused. Please submit this form to be contacted when the program re-opens.
Donor Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Purpose of Donation (select one)
*
In Memory Of
In Honour Of
Name to Appear on Plaque
*
Additional Wording (Optional)
Plaques may include up to two sentences of additional text (approximately 30-35 words maximum).
0/35
Comments or Special Instructions
Submit
Should be Empty: