Memorial Tree Application for BCCB 2023
Please complete or print to complete the application below for your memorial bench.

Please note that BCCB can not guarantee all applications will be approved. A BCCB Staff Member will contact you if your application is approved.

Please read through the following conditions before completing the contract:

Standard memorial tree donations are under $200.00. Other donation amounts are welcome, but will not be guaranteed. A BCCB staff member will be in contact with you to discuss tree options and placement.

Planting and tree availability relies heavily on favorable weather.

Memorial payment can be made by cash or check. Checks can be made out to:

Benton County Conservation Foundation
5718 20th Ave Drive
Vinton, IA 52349

BCCB will guarantee a standard memorial tree for two years.

If damage occurs during guaranteed timeframe, a request for replacement or relocation can be discussed.

If damage occurs after guaranteed timeframe, options for retrieval or relocation can be discussed.
Sign in to Google to save your progress. Learn more
Email *
Agreement - I have read and understand the terms above. *
Memorial Title (optional)
Your First Name *
Your Last Name *
Your phone number *
Preferred form of contact *
Name of the person(s) being honored or reason for memorial *
Name of person(s) or organization funding the memorial tree *
Form of payment *
Requested Park *
Specific requests for locations within the park you selected
Request for plaque: Wording can be three to four lines. See example below. *
Captionless Image
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Benton County Conservation Department. Report Abuse
Google Forms