Application for memorial bench, plaque or tree in Harlow Town Park
Name
Address
Contact
phone
number
Email
address
Application
for:
Memorial bench
Memorial sole plaque on
memorial bench
Memorial shared plaque on
memorial bench
Memorial tree
Details of
person
being
remembered
or other
reason
Wording
requested
for bench
inscriptions
I have read and agree to the Council’s Memorial policy for the Town Park.
Signed
Print name
Date
Please return completed form by email to: mike.levett@harlow.gov.uk
You can also post the form to: Mike Levett, Pets' Corner, Park Lane, Harlow CM20 2QG
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