Bench Dedication Expression of Interest Form Your detailsTitleFirst nameLast name AddressEmail addressContact number Bench location and donation feePlease select one or more of the following Gardens at which you wouldlike to dedicate a bench noting the corresponding donation feeRoyal Botanic Garden Sydney and The Domain SydneyBlue Mountains Botanic Garden Mount TomahAustralian Botanic Garden Mount AnnanAll below tiers are subject to availabilityRoyal Botanic Garden and The DomainTier 1 – Iconic Harbour Views: $19,500Tier 2 – Premium Garden Locations: $16,500Tier 3 – Outer Garden Locations: $12,500Blue Mountains Botanic GardenTier 1 – Iconic Garden Locations: $15,000Tier 2 – Outer Garden Locations: $12,500Australian Botanic GardenTier 1 – Iconic Garden Locations: $15,000Tier 2 – Outer Garden Locations: $12,500Plaque inscriptionPlease write your proposed plaque inscription below (refer to clause 6.2 ofthe Bench Dedication Terms and Conditions for guidance). We reserve the right to request further information regarding your proposed inscription. 25 words maximum.I have read and agree to the Bench Dedication Terms and ConditionsYesI would like to be contacted by Botanic Gardens of Sydney for any upcoming events and/or donation opportunities.YesNoOnce you have submitted this form, the Development Team will contact you for payment and to finalise your bench dedication.