Memorial Wall Application | District of Port Edward

POLICY # 2017-1

TOPIC: MEMORIAL WALL PLAQUE

OBJECTIVE: The District of Port Edward requires a policy to administer the ordering of plaques for the Memorial Wall.

POLICY:
The Port Edward Memorial Wall was a project that the District of Port Edward and the Port Edward Lions' Club members worked on where the purpose of this Memorial Park was to provide an opportunity to commemorate the life of a loved one.

SCOPE/ APPLICATION:
An application and payment will be required in order for a plaque to be installed in the Memorial Wall (see attachment). The fee of the plaque will be seventy five dollars ($75), which will pay for the plaque and installation.

Once an application is received and paid for, the District of Port Edward staff will order the plaque and make arrangements for it to be installed.

Once the installation of the plaque is done, the applicant will be notified.

A Periodic Memorial Wall service will be organized.

Please note that you can have up to two names on one plaque.

DEDICATION

Name (1)*:

Date of Birth (1)*:

Date of Death (1)*:

Name (2):

Date of Birth (2):

Date of Death (2):

DONOR INFORMATION

Name of Donor*:

Mailing Address*:

Phone*:

Email Address*:

AUTHORIZATION

*I agree to Collection of Personal Information:

The personal information submitted in this form is collected in accordance with Section 26 (c, d, e) of the British Columbia Freedom of Information and Protection of Privacy Act (FOIPPA) (the “Act”) and will be used for the purpose of the Memorial Wall Application. Please be advised that the District of Port Edward is a “public body” as defined in the Act. Questions about the collection, use and disclosure of this information can be directed to the District of Port Edward’s Corporate Office at 250-628-3667 or .

Date of Submission: