Memorial Plaque Request Form

Please complete and mail this form along with payment to:
Bowen Island Memorial Garden Society
RR#1 R11,
Bowen Island, B.C. V0N1G0

Each Plaque cost $85.00 Canadaian Funds
Please make cheque, postal Money order or International Bank Draft payable to:
Bowen Island Memorial Garden Society

You may call 604-947-9565 for more information

Please Click Print This Page after completing the form to the Signature Block

Name on Plaque:
Date Of Birth:
Date of Death:
Name Of Donor
Address
City
Province/State

Country
Postal/Zip Code
Phone Number
Email Address
Your Comments

Signature