Memorial Application

Please complete as best you can and forward to The Secretary.

We require the details of three applicants - representing different branches of your family.

An acknowledgment will be given that the application has been received. Allow up to three months for a formal reply.

Ancestor(s) to be memorialised:

  • Full name at birth
  • Other names (preferred name, nickname)
  • Date and place of birth
  • Date and place of death
  • Occupation
  • Father's name
  • Mother's name
  • Names, dates and places of birth of siblings
  • Name and date of arrival ship
  • Why is this person significant to Kangaroo Island's history?

Spouse(s) of the ancestor: (all spouses need to be shown)

  • Date and place of birth
  • Date and place of death
  • Father's name
  • Mother's name
  • Name and date of arrival ship
  • Date and place of marriage

Your details

  • Full name
  • Address
  • Email address
  • Contact number(s)
  • How are you related to the ancestor? (please show the pedigree back to the ancestor)

First supporting applicant's details (mandatory) (must not be of your immediate family, preferably from another branch of your family tree). If, for an existing site, you hold the interment right, this section can be skipped.

  • Full name
  • Address
  • Email address
  • Contact number(s)
  • How is this person related to the ancestor? (please show the pedigree back to the ancestor)
  • How is this person related to you?

Second supporting applicant's details (mandatory) (must not be of your immediate family, nor the immediate family of the person above, preferably from another branch of your family tree). If, for an existing site, you hold the interment right, this section can be skipped.

  • Full name
  • Address
  • Email address
  • Contact number(s)
  • How is this person related to the ancestor? (please show the pedigree back to the ancestor)
  • How is this person related to you?

Memorial details

  • Anticipated position of memorial (please give exact location)
  • Have you already applied for a development application? If so, give details
  • Approximate size, and type of memorial (e.g. bronze plaque, headstone, information sign, etc.)
  • Proposed wording
  • Proposed images (KIPA may add its own logo and QR code).

Research already available

  • Please attach any relevant research already done, with full sources, which substantiates the proposed wording.

Research required

  • Do you have any specific additional research you want help with?

Funding

  • How much money is the family prepared to provide? (An agreed amount will need to be paid after the proofs are agreed to, and prior to the manufacturing process)
  • How much money does the family expect KIPA to contribute (through grants, etc.)? (We cannot guarantee that we can provide any funds).

Commissioning / unveiling ceremony

  • Proposed date (Allow minimum 12 months from the estimated date of acceptance of the project) (Do not publicise any date, e.g. inviting your family members, without KIPA's approval) (Our preferred date is Settlement Day, 27th July of each year).
  • How many will be present and who will officiate?
  • Special instructions

In submitting this application you accept that KIPA needs to be satisfied that the final wording and positioning is authentic, appropriate and accurate as possible. KIPA reserves the right to remove, or request from the family that the memorial be updated if subsequent evidence is found to bring into question the validity of the wording, images or location.

Last updated: 7th June 2016