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Zorra Memorial Tree Programme

Please plant a tree under the Zorra Memorial Tree Programme in memory of

Memorial Tree planted on behalf of (list names)

Tax receipt to be issued to:

Name

Phone Number

Address (including Street address, City, Province, & Postal Code)

Acknowledgement card to be sent to:

Name

Address (including Street address, City, Province, & Postal Code)

Method of payment $40/tree

Mail cheque to Township payable to UTRCA

eTransfer to accountsreceivable@zorra.ca

Purchase Memorial Tree Sign Plaque(s) for an additional fee ($20.00 per plaque)

Additional Plaque(s)

Yes

Method of payment

Mail cheque to Township payable to Township of Zorra

eTransfer to accountsreceivable@zorra.ca

Location of plaque(s):

Embro Pond

Grace Patterson Park Thamesford

Harrington Pond

Signature

Clear

The personal information, as defined by the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), is collected under the authority of the Municipal Act, 2001 and in accordance with the provisions of MFIPPA. Personal information on this form will be used for the purpose of the Township of Zorra’s Memorial Tree program, and the name of the deceased may be displayed on a dedication plaque. If you have any questions regarding this collection, use, and disclosure of information, contact the Township of Zorra Municipal Clerk 519-485- 2490.

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Zorra Memorial Tree Programme

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