Apply for memorial bench

Your details
2. Your name
  1. Title*
  2. Title*
  3. First name*
  4. Last (family) name*
3. Your email
  1. Email address*
  2. Confirm email address*
4. Phone number
Your address
4. Postcode
6. Select your address
7. Address
  
  You have selected:
  
  Address
Memorial bench
1. Where you would like the bench to be located? Please be as specific as possible.*
2. Please enter the wording for the plaque.*
Privacy notice
1. Please read the below privacy notice, and tick to confirm that you agree.
2. I agree to the [privacy notice|https://www.southtyneside.gov.uk/article/73460]*

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