Memorial Grove Bench Stone Reservation Form

Full name typed as it should appear engraved on the stone.

First Name of the Person (How the stone will be engraved) (e.g., Winifred)

Middle/Maiden Name (Optional)

Last Name of the Person (How the stone will be engraved) (e.g., Boynton)

Birth year

Year person to commemorate was born as it should appear engraved on the stone.

Death year

Year person to commemorate passed as it should appear engraved on the stone. If person is alive, this information will be collected upon passing.

Number assigned to stone you wish to have engraved

See the Memorial Grove Engraving Instructions here.

Please list your top 3 stone preferences.

Your First Name

Your Last Name

Suffix

Your email address

Your Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Your phone number

Method of payment

Please select the payment method you prefer. If you choose to mail in a check, please mail to: ��ö��ܲԻ�� Memorial Grove, PO Box 10, Baileys Harbor, WI 54202. You will be notified when your check is received.

If you choose to pay by credit card, please follow this

or call us at 920-839-2216. We accept Visa, MasterCard, and Discover.

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