Funeral Request Form

Funeral/Memorial Service Information

* Indicates required field

Requested Date *

Requested Time *

Name of Deceased *

First

Last

Relationship to you *

Your Name *

First

Last

Your Home Phone Number *

Your Cell Phone Number *

Your Address *

Line 1

Line 2

City

State

Zip Code

Country

Your Email *

Please check all that apply *

Deceased a member of NSUMC You are a member of NSUMC A family member is a member of NSUMC

Additional Information you feel we should know *

Submit

Please allow 48 hours for a response