Memorial Donation and Gift Agreement Form Name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Park Location(Required)Select OneCrosbie Wildlife & Youth CenterDog Creek ParkDouma ParkMill Creek ParkTjossem ParkOtherProposed Location(Required)Description of item to be placed(Required)Select OneBenchSquare TableTableTreesOtherPlaque Inscription(Required)Consent(Required) By submitting this form you are agreeing to the following:Terms and Conditions of Memorial Donations and Gifts Placement of memorials must be compatible with existing development plans. Memorials are not permitted within designated wildlife management areas. Memorials shall not detract from or overpower the scenic or architectural values of the existing environment. All memorials will be constructed of materials that meet the design and maintenance considerations of the O'Brien County Conservation Board. Memorials must have consent from the most immediate surviving family and/or legal custodions of the deceased. Large scale memorial donations may be considered on a cose-by-case basis. Non-designated monetary memorial donations will be used to meet current needs of the OCCB. Memorial gifts to O'Brien County Conservation Board are considered outright and unrestricted donations. O'Brien County Conservation Board does not guarantee permanency of the accepted donation. If a memorial must be removed or relocated OCCB staff will attempt to notify the donor at the address shown on this form. The donor declares to have read the Terms and Conditions of Memorial Donations and Gifts and agrees with the conditions set forth in the agreement. Click to read the full Memorial Donation Policy
