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  1. Indicate the park where the commemorative tree or bench is to be located.

  2. Dedication Plaque (Three-Line Maximum)

    If requesting a bench with a dedication plaque, please complete the fields below.

    The dedication language is subject to review and approval by the City of Rockville.

  3. Confirmation*

    I have read and understand the Commemorative Tree and Bench Program. I agree to the terms indicated, confirm my intent to purchase a tree or bench and understand that I must provide payment to the City of Rockville along with this completed application.

  4. Leave This Blank:

  5. This field is not part of the form submission.