Obituary Online Form

Are you a conference employee?

Yes No

Your Email

Phone Number

What is the name of the conference you are apart of?

First Name

Middle Initial

Nickname (optional)

Maiden Name

Last Name

Date of birth

City of birth

State of birth

Country

United States of America Other

If you selected "other," please indicate country

Date of death

Age at time of death

City of death

State of death

Select one

He was a member of She was a member of

Name of Church

City, State of Church

First name of spouse

Middle initial of spouse

"Nickname" of spouse

Maiden name of spouse if applicable

Last name of spouse

Son(s): First name (First name of spouse & maiden name if different) Last Name

Stepson(s): First name (First name of spouse & maiden name if different) Last Name

Daughter(s): First name, “maiden name if used” (First name of spouse) Last Name

Stepdaughter(s): First name, “maiden name if used” (First name of spouse) Last Name

Foster child(ren)

Father

Mother (include maiden name)

Brother(s)

Stepbrother(s)

Half brother(s)

Sister(s)

Stepsister(s)

Half sister(s)

Other relatives

Number of grandchildren

Number great-grandchildren

Number of step-grandchildren

Number of step-great-grandchildren

Number of great-great-grandchildren

Number of step-great-great-grandchildren

Preceded in death by (list immediate family members only)

Please select one

Funeral Memorial Private service No services held

Will the service be livestreamed?

Yes No

If yes, please provide URL or venue host

Please select the type of service

Interment (Burial) Inurnment (Cremated) Other

Date of service

Will the service be held at a later date?

Yes No

Title of officiant

Pastor Elder Deacon Other

If other, please explain

Please select one

Internment

Inurnment

Name of cemetery (if interment was selected)

Name of facility (if inurnment was selected)

City

State

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Obituary Online Form

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Place of death

SURVIVING family members:

DO NOT LIST DECEASED FAMILY MEMBERS.

Services

Type of Service