Plaques and Memorials Application Form

Please complete the form below to request a plaque or memorial to be established within the City of Greater Geelong.

Please note: This is an expression of interest only and your request will need to be considered in accordance wtih Council policy.


Fields marked with * are required

Memorial Plaque Details
Preferred wording for the memorial/plaque which will be subject to council approval.


Please ensure that your request is in accordance with Council policy and conditions.




Applicant Details
Your details are required to enable us to respond to your request.







We are requesting you phone number in the event that we have futher questions in relation to your application.


Acknowledgement


Conditions
Please refer to our Conditions




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