1

WOUNDED WARRIORS CANADA

(Canada Revenue Agency – Charity # 82808-2727-RR0001)

Park of Reflection

Tribute StoneOrder Form

The Park of Reflection is intended to provide a gathering space to give thanks, show respect, and provide sanctuary for our ill and injured uniformed service personnel, their families, and Canadians alike. This will be the first of its kind in Canada, proudly situated in Whitby’s Cullen Gardens.

Themen and women of our uniformed service dawn their uniforms each day with unlimited liability placed on their health and safety – risking their lives for our safety and security both domestically and internationally. Members of our uniformed service personnel include those from the Canadian Armed Forces, RCMP, Police, Fire, EMS, Coast Guard and Border Security Service personnel.

The park’s design symbolizes and augments their journey back to health and represents the sacrifices those in uniform have and continue to make for our peace and security. The Park of Reflection will be a place for all to visit, reflect, pay tribute, and share in remembrance that freedom is not free.

As part of the design of the Park, tribute stones are being used as a way to honour individuals who have become ill or injured in their respective line of duty. The tribute stones are 12” x 12” and will be placed within the parks inner labyrinth.

Each tribute stone can be engraved with a 5” x 5” crest withup to four lines of 20 characters including spaces and punctuation per line which can include anything from the person’s name, unit, position, date of service, date of injury or anything that the person who the stone is being commissioned for wishes.

Tribute Stone $500.00 Bench with Inscription$5000.00

Top of Form

Purchaser Information:

Purchaser Name (required):______

Address:______City:______

Province: ______Postal Code:______Telephone: ______

Email (required): ______

Please complete the following information about the individual the stone is being purchased for:

First Name: ______Last Name:______

Are they still serving or are they retired?YesNo

What is there branch of Service? ______

Is this individual still alive: YesNo

If yes, please provide their E-mail:______

If no, please provide their next of kin E-mail: ______

Tribute Stone Engraving

Note: All text will be centered on the stone. Each line is limited to 20 characters.

Crest:______

Line 1:______

Line 2: ______

Line 3: ______

Line 4:______

Special Requests:______

______

Payment Options

How would you like to pay for this Tribute Stone?

Cheque or money orderVisaMaster Card

Please do not hesitate to contact us at

WOUNDED WARRIORS CANADA 310 Byron Street South, Suite 4, Whitby, ON L1N 4P8 Tel: (888) 706-4808