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Applicant’s Name: _ Phone: Email: Address: _ _ Name of Individual Being Honored: Desired Location of Bench: _ Text for Plaque: _ Prices for bench and/or plaque options will be based on current manufacturer’s quote. Please select your preferred options, and we will provide you with a quote prior to finalizing your request. Plaque Options: _ Cast Aluminium 3”H x 10” L $ 175.00 Cast Bronze 3”H x 10” L $ 218.00 Bench type: Cedar / Frame Green $1124.00 Thank you for considering the opportunity of placing a memorial bench within our park system. Please note, the Whitefish Parks and Recreation Department will have final approval of the location of the bench. The City reserves the right to relocate or replace the bench with a similar product, should the need arise in the future. *Please note, as per Ordinance 7-3-11, no person shall, in any park or other public grounds, erect, maintain, use or occupy any structure or unattended installation or display. This includes but is not limited to flowers, decorations, and other memorabilia. Signature: Date: OFFICE USE Bench: $ Plaque: $ Total Due: $ Memorial Bench Program