Commemorative Tree Program Application Form

Commemorative Tree Program Application Form

Due June 30th Annually
Please fill in the following information:
SECTION 1: CONTRIBUTOR INFORMATION
Name (First and Last Name):*

First NameLast Name
Date:*

MonthDayYear
Date
Birthdate: (DD-MM-YYYY)*

MonthDayYear
Date
Complete Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Format: (000) 000-0000.
Email:*
example@example.com
Secondary Contact Name:*
Secondary Contact Phone Number:*
Format: (000) 000-0000.

Please complete this form by clicking “Submit” at the bottom of the page. Once submitted, the Commemorative Program Application Form will be automatically forwarded to St. Clair Township’s Community Services Department for review.

After the form has been reviewed and approved, we will contact you regarding payment.

If you have any questions at any time regarding your application, please feel free to contact us at info@stclairtownship.ca or by phone at 519-867-2651. Our staff would be happy to assist you.

Personal information is collected under the authority of the Municipal Act, 2001 for the purpose of administering community programs and services in the Township of St. Clair. Questions about this collection may be directed to the Clerk, Township of St. Clair, 1155 Emily Street, Mooretown, ON, 519-867-2021.
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