Order form for a plaque

Please use this secure form to order your plaque. Fields marked with an asterisk are required. You can download some Guidance Notes in two formats: .doc or .pdf

The maximum number of characters allowed (including spaces and punctuation) are shown in parenthesis against each field title, where relevant. The program will tell you when you try to send the form if you have exceeded the allocation.

Also, to avoid nuisance completions by automatic spammers, we have included a verification box, which should be completed by copying exactly the letters and numbers you see in blue on the screen.

Also, we would like to compile a Book of Remembrance with not only the names of the people remembered on the Plaques, but with photos and other information on their lives.
We would be very happy if copies of such photos and information could be sent to us for that purpose.
Thank you.

This secure email form is supplied courtesy of Dagon Design