Adopt-A-Bench Request Form

Adopt-A-Bench Request Form

Burgaw Parks, Recreation & Tourism
With a donation, Burgaw Parks, Recreation & Toursim will install a bench on municipal lands in honor or in memory of your loved one, friend, or co-worker. This bench will provide the park, greenway, or downtown area with an extra amenity by helping Burgaw Parks, Recreation & Tourism continue to create a healhier more sustainable Burgaw.

We will send a personalized card to inform recipients that you have made a gift to install a bench in their name that includes a customized plaque.
Name of Donor:

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location Request: Please suggest 3 locations throughout the Burgaw area that you prefer.
Ex: Hankins Park, Wright Street, Osgood Canal Greenway & Urban Trail.
Please provide name and address of recipient if you want a letter sent to a family or friend of memorial contribution:
Make sure that you use a valid United State address.
Plaque Text: (Inscription may include 6 lines of text, up to 24 characters per line including space).
Donor Signature

Clear
Should be Empty: