Hospice Alliance Event

Join us for the
Service of Remembrance and
Memorial Brick Dedication

Wednesday, June 23rd at 5 p.m.
The Kemper Center, Kenosha, WI
You are invited to join us for our
Service of Remembrance and Memorial Brick Dedication
honoring the memory of your loved one.

Please RSVP by Friday, June 18th.
You may also include your loved ones name
to be included in the service program.

Your Name: *

First Name Last Name

Number of friends or family attending: *

Name(s) of your loved ones to be remembered in the event program. If your loved one is a veteran, please include their branch of service:

Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number: *

Area Code Phone Number

E-mail to receive any event notifications:

I give my permissions to publish the name of my loved one(s) in the service program. *

Yes No