Memorial Service Request Form

Contact info: (503) 656-9144 | info@oregonarmenianchurch.com
Memorial Service Request Form
Memorial Service Information
Name of Deceased

First NameLast Name
Date of Birth

MonthDayYear
Date
Date of Death

MonthDayYear
Date
Place of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Service requested by

First NameLast Name
Relationship to Deceased
Relationship to Deceased

Other
Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Your Phone
Format: (000) 000-0000.
Your E-mail
example@example.com
Service to be held at

MonthDayYear
Date
Hour MinutesAM/PM Option
Officiating Clergy
Language of Service
Funeral Home
Funeral Home Contact Name
Funeral Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Wake Date (if applicable)

MonthDayYear
Date
Burial or Cremation
Burial or Cremation: Location
Flowers or in lieu of Flowers (donations may be sent to St. Kevork Armenian Church)
Memorial Luncheon
Memorial Luncheon Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Memorial Luncheon Date and Time

MonthDayYear
Date
Hour MinutesAM/PM Option
SUGGESTED DONATION: $300

It is customary to acknowledge the officiating priest and assisting deacon separately.
Donation

Memorial Service Donation

$300.00

Hall Rental

$300.00 Hall Cleaning Options

Additional Donation

$25.00 Quantity

Subtotal

Tax

Total

Memorial Service Information