2. 

4. Memorial Tree/Bench Request Form

6. Name *
7. Street Address*
9. City *
10. State*
11. Zip Code *
13. Phone number *
14. Email address*
16. Memorial Type Requested*
    -- Select One --Memorial TreeMemorial Bench
18. Memorial or Special Event *
20. Location (First Choice) *
21. Location (Second choice) *
23. Requested tag message (for tree) or Plaque inscription (for bench)*
25. For memorial tree only, please select type of tree*
    -- Select One --ShadeFlowering
27. Notice

    My signature below states that I understand this donation is for the lifetime of a bench purchased. Tree purchases are guaranteed for two years. In addition, I understand that the City of McPherson Public Lands and Facilities Department is the ultimate authority for determining the location and/or type of tree or bench that is purchased as well as the final wording on the memorial tags. If this request can be met, a representative from the McPherson PLF department will reach out with further information and optional payment methods. 

29. Signiture*
30. Date Signed*
    Date Signed
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field