If you wish to participate in the Banff National Park Memorial Bench Donation Program, please complete and submit this Application Form by one of the options described below.

Printable version (PDF 360KB)

BANFF NATIONAL PARK MEMORIAL BENCH DONATION PROGRAM APPLICATION FORM

Donor Contact Information*

Donor 1 Contact Information (primary contact):

First and Last Name:_______________________________________________________________________

Mailing Address:__________________________________________________________________________

Home Phone Number:___________________________________________Other:______________________

Email:___________________________________________________________________________________

Donor #2 Contact Information (if a joint donation)

First and Last Name:_______________________________________________________________________

Mailing Address:__________________________________________________________________________

Home Phone Number:___________________________________________Other:______________________

Email:___________________________________________________________________________________

Donor #3 Contact Information (if a joint donation)

First and Last Name:_______________________________________________________________________

Mailing Address:__________________________________________________________________________

Home Phone Number:___________________________________________Other:______________________

Email:___________________________________________________________________________________

* Please designate a primary contact for joint donations. All correspondence will be sent to this individual.

Please indicate your top three (3) choices based on bench availability:

Preference #1
Bench Identification Number: Location: ______________________________________ Bench Number: ____________________ 
 
Preference #2
Bench Identification Number: Location: ______________________________________ Bench Number: ____________________ 
 
Preference #3
Bench Identification Number: Location: ______________________________________ Bench Number: ____________________ 

Plaque inscription (maximum 40 words up to 4 lines)

(Line 1)_________________________________________________________________________________
(Line 2)_________________________________________________________________________________
(Line 3)_________________________________________________________________________________
(Line 4)_________________________________________________________________________________

I hereby agree to participate in the Banff National Park Memorial Bench Donation Program. I have read, understand and comply with the program guidelines.

_______________________________________

Donor #1 first and last name (please print)

   ______________________________                    ___________________
                         Signature                                              Date mm/dd/yyyy

 

Payment Options

Cheque

Made out to the Receiver General of Canada 

Credit Card:

Visa  MasterCard  American Express 

Credit Card Number: ____________________________________

Expiry Date (mm/yy): _____/_______

Cardholder name as appears on credit card: _________________________________________________

Signature__________________________________________

Please indicate the donation amount $__________________

 

For office use only

I hereby accept the information provided in this donors application and agree that Parks Canada will comply with the program guidelines.


________________________________________________________________________________
Park Superintendent or name and title of Parks Canada representative (please print)



____________________________________                                    ________________________
                    Signature                                                                            Date mm/dd/yyyy

Bench Expiration Date:___________________________________

 

 

For finance office use only

Donation amount: $_____________________________________

Payment Type:_________________________________________

Received By:___________________________________________

Signature:_____________________________________________

Date Received:_________________________________________

Please submit your completed application:

By Mail

Attention: Visitor Experience Donation Program
101 Mountain Avenue
P.O. Box 900
Banff, AB, T1L 1K2

By Email:

Email: pc.experiencebanff.pc@canada.ca