SportsManual_Flip

APPENDIX “G” – Application for Name Dedication

DOUGLAS COUNTY BOARD OF COMMISSIONERS Application for Name Dedication or Memorial Placement DCPRD (770) 920-7129

Please complete the following information and submit this application to your respective Youth Sports Coordinator to be forwarded to the Douglas County Parks and Recreation Department for approval. Once approved by the Douglas County Board of Commissioners, you will be notified. Date of Request: __________________________________ Name of Individual(s) or group requesting dedication/memorial: _______________________________ ___________________________________________________________________________________. Phone numbers (home, work, cell): _______________________________________________________ Facility: ____________________________________________________________________________ Current Name of Facility: ______________________________________________________________ Location: ___________________________________________________________________________ Name to be dedicated: _________________________________________________________________ Type of memorial to be erected: _________________________________________________________ Justification: ________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Additional Information/Comments: ______________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ I request that the Douglas County Board of Commissioners review and consider the following request for a name dedication and/or placement of a memorial:

MEMORIALS OR PLAQUES WILL BE AT THE EXPENSE OF THE APPLICANTS