Funeral Ceremony Your Name* Address* City* State* Zip* Phone 1* MobileHomeWork Phone 2* MobileHomeWork Email* Are you a member of this church?* Yes | No Funeral Information Name of Deceased* What was the death date?* Was the deceased a member of this church?* Yes | No Proposed Funeral Date* JanuaryFebruaryMarchMayJuneJulyAugustSeptemberOctoberNovemberDecember 1234567891011121314151617181920212232425262782930 Proposed Funeral Time* Start Time End Time How many people are you expecting for the reception? Funeral Home Contact Information Funeral Home Name* Funeral Director's Name* Address* City* State* Zip* Phone 1* MobileHomeWork Phone 2* MobileHomeWork Email* Funeral Needs Do you need a minister to perform the funeral? Yes | No Do you need a musician for the funeral? * Yes | No Do you need special music for the funeral?* Yes | No Do you desire to have the reception at the church? * Yes | No Who will cater the reception?* Caterer’s Phone # [recaptcha id:captcha] Δ
