Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Terms *

Subject to the policies and procedures as may be changed from time to time, this application is accepted. Roswell Presbyterian Church agrees to inter the ash remains, when presented, of persons listed in the above application, or other qualified persons who may be designated at a later date, and to furnish an appropriate cast bronze nameplate.

I have read and agree to the policies and procedures that govern administration of the Memorial Garden. I understand that procedures governing the Memorial Garden may be modified or changed from time to time without advance notice by the Session of Roswell Presbyterian Church. I agree to any persons who may choose to use the rights obtained under this application.

Fees *

The purchase fee covers the cost of construction, maintenance of the Memorial Garden, and a memorial nameplate.

I agree to pay the fee of $750 per person will be paid at the time of application.