Cornerstone Memorial Park Donation Form
I would like to donate the following memorial:
________ Park Bench with Memorial Plaque ($250 each)
________ Tree with Memorial Plaque ($250 each)
________ 8” x 8” Paver with Inscription ($50 each)
Inscription (32 character spaces or less, e.g., “In Loving Memory of ………”):
________________________________________________________________________________________________
Your Name __________________________________________________________________
Address _____________________________________________________________________
Phone ______________________________________________________________________
Email _______________________________________________________________________
Donations are tax deductible. Please make check payable to
“Eagle Lake Community Church” and mail with this form to:
Eagle Lake Community Church
ATTN: Cornerstone Memorial Park
687-905 Lakeview Dr.
Susanville, CA 96130