Memorial Bench 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:

Placement of all memorials must be approved by BCCB.

The cost for a memorial bench is $800.00. This cost covers the bench, concrete, installation, and the memorial plaque.

Installation timing relies heavily on favorable weather and available supplies.

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 memorial bench for eight years.

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

If damage occurs after guaranteed timeframe, a request for retrieval or relocation can be discussed.
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Email *
Agreement - I have read and understand the terms above. *
Newly installed Memorial Bench at Hannen Lake Park
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 bench *
Form of payment: *
Requested Park *
Specific requests for locations within the park you selected
Request for plaque: Wording can be three to four lines. A few samples are attached. *
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A copy of your responses will be emailed to the address you provided.
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