MEMORIAL GARDEN PLANT ORDER FORM

I _____________________________ want to order a planting in (honor)

                  (your name)

(memory) of ______________________________________________

                                      (name or memorial or honoree)

All plants will be placed around the inside of the Martin Health Center fence.

Plant a plant of $30 value. Yes ____

Plant a plant of $65 value. Yes ____

I want to specify a $30 plant: (circle choice)

I want to specify a $65 plant: (circle choice)

I would like to check on having a _____________________ planted instead. We can research to see if a specific plant will fit in and give you a cost.