Funeral Planning form

Today's Date

Name of Deceased *

First

Last

Were they an active member?

Yes
No

Date of Death

Age of Death

Requested Date and Time of Funeral

Date

Time

Applicant contact Information

Name of Applicant *

First

Last

Are you an active member?

Yes
No

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship to Deceased

Mobile Phone Number

Email *

Funeral Information

Name of Funeral Home

Contact at Funeral Home

First

Last

Contact Telephone

Section Divider

Location of Internment

Address Line 1

Address Line 2

City

State

Zip Code

Time of Internment

Repast and Fees

There is a minimum deposit of $850 for Building operating cost for non-members that is due one day prior to the funeral.

Will there be a repast?

Yes
No

Will repast be before the interment or after?

Before
After

How many people do you expect for the repast?

Checkbox Items

Officiating Pastor
Soloist

Please check all the services that you will need.