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Haldimand County's Commemorative Program Application/Agreement

Applicant Information

First name

Last name

Phone

Address

Town/City

Postal code

Commemorative Item(s)

Bench pricing is subject to the supplier and tree pricing is defined by the County's User Fees. Bench and tree applications can be made at any time however, tree plantings take place in the spring - only those applications made by December 31 of each year will be included in the following spring planting.

Select your commemorative item(s)

New bench with a plaque and concrete pad (Approx. $4,000 - $6,000)

Existing bench with plaque (Approx. $1,700 - $2,300)

Commemorative tree with plaque (As per current user fees)

Commemorative tree without a plaque (As per current user fees)

Other commemorative item

Preferred location

Image of preferred location

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Allowed extensions pdf, docx, xlsx, jpg, jpeg, gif, png, tif

Additional Information

Please sign

Clear

Acknowledgement

I understand that the Commemorative Program Costing is subject to Supplier Costing for Benches and current County user fees for Trees.

Notice of Collection

Personal Information contained on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of administering the Commemorative Program. Questions about this collection may be directed to the Community Development and Partnerships division at 905-318-5932 or partnerships@haldimandcounty.on.ca.