SEABROOK BEACH CIVIC ASSOCIATION BENCH REQUEST APPLICATION
PLEASE PRINT CLEARLY
NAME: Person requesting bench ____________________________________________
ADDRESS: ___________________________ CITY/TOWN: ______________________
STATE: ______________________________ ZIP CODE: ________________________
PHONE NUMBER: _____________________ EMAIL ADDRESS:_________________
RESIDENT STATUS: (Circle One)
Full Time Resident, Part Time Resident, Non Resident
HONOREE: _____________________________________________________________
NAME: _____________________________________________________________
RESIDENT STATUS: Full Time, Part Time, Non resident, Deceased (circle one)
SBCA MEMBER: (Circle One) Yes No Years as a Member: ___________
SBCA COMMITTEE AFFILIATION: Membership, Safety, Beautification, etc.
__________________________________________________________________
BENCH LOCATION REQUESTED:
Street Name: _____________________________ (Circle One) Roadside, Beach
NAME PLATE PRINTING: ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Standard bench nameplates are 3” x 10” with 1/2 inch letters .
Wording should be limited to 50-55 letters.
PLEASE MAIL TO: KEN CLARK
PO BOX 2120
SEABROOK NH, 03874