Pre-Planning Memorial Service Form

Disclaimer:
This document is intended for informational purposes and to assist those making arrangement at the time of death. Main Line Unitarian Church will endeavor to support the family but assumes no responsibility for arrangement as directed by those legally responsible,

Name

This address will receive a confirmation email

Phone

Address

Date of Birth

Church Member Status

Please select all that apply.

Member Regular Attender

Next of Kin

Primary Contact for Arrangement at the Time of Death (Name, Relationship, Phone/Email):

Children/Family Members (names and contact information):

Memorial Service Preferences

Do you desire a memorial service?

Please select one option.

Yes No

May your family make final decision regarding arrangements?

Please select one option.

Yes No Not Applicable

Do you have specific suggestions for the service:

Favorite reading (poems, prose, sacred or inspirational texts):

Music (composers, instruments, performers, or specific hymns or selections):

Preferred Participants (ministers, friends, relatives, speakers, musicians, congregational sharing):

May the service be livestreamed on YouTube?

Please select one option.

Yes No Undecided

Additional Remarks or Requests:

Final Arrangements

Do you wish to have a plaque in the MLUC Memorial Garden

Please select one option.

Yes No Undecided

Would you like an Interment Ceremony? (Please specify if you are looking for anything specific.)

Statement of Intent

I affirm that the above information reflects my intentions and wishes to the best of my knowledge and understanding. I understand that the final arrangement may be adjusted by my family and/or legal representatives as circumstances require.

Pre-Planning Memorial Service Form

Description

Please Fix the Following