CLM Contact Form

Funeral Website Request & Information Form
Name*

First NameLast Name
Note: Your website domain will be firstnamelastnamecelebrant.com (ex. wayneprevettcelebrant.com). We do permit you to put a company name in the header of each webpage instead of your name. (Ex. Celebrating Memories London)
Do you wish to use a company name in the header of your webpage?*

NoYes
Company Name to use in the header of your webpage?*
Your E-mail*
Should be a specific email for your clients. Ex. name@gmail.com
Phone number for clents to contact*
Website Choice*
Ceremony Fee*
Other CLM training you have taken*

Wedding OfficiantNew LifeNone
In addition to providing a funeral, memorial and graveside service, please check all that apply to you below.:*

Officiating a Service of RemembranceMeeting the terminally ill to help them plan their memorial serviceMeeting with families in person to help plan the memorial serviceAssist in writing a eulogyAssist in choosing appropriate music for the memorial serviceDirecting families and individuals to grief support networksGuest speakerKeynote speaker for seminarsSeminar presenter on the topic of planning a memorial serviceInspirational speakerNone of the aboveOther
Facebook Business Page URL**
**Facebook URL can be added later.
Payment Details

Information protected by GlobalSign*

Website$99.00CAD

Total $0.00CAD

Funeral Website Request & Information Form