Apply for a memorial bench

Your details
2. Your name
  1. Title*
  2. Title*
  3. First name*
  4. Last (family) name*
3. Your email
  1. Email address*
  2. Confirm email address*
4. Phone number*
Your address
4. Postcode
6. Select your address
7. Address
  
  You have selected:
  
  Address
Memorial bench
1. Which option best describes your request?*
  
  I am applying for a new bench
  
  I am applying to add a plaque to an existing bench
2. Where you would like the bench to be located?
  Please be as specific as possible
3. Where is the bench located?
  Please be as specific as possible
5. Please enter the wording for the plaque. Plaque wordings can be a maximum of 7 lines with 36 characters per line; this includes commas and spaces etc.
6. Lines
  1. Line 1
  2. Line 2
  3. Line 3
  4. Line 4
  5. Line 5
  6. Line 6
  7. Line 7
Terms and conditions
1. Please read the below terms and conditions, and tick to confirm that you agree.
2. I agree to the [terms and conditions|./article/23292]*
Privacy notice
1. Please read the below privacy notice, and tick to confirm that you agree.
2. I agree to the [privacy notice|./article/6743]*

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