LIFE EVENTS FORM
Please review our Membership Benefits before completing this form.
Member's Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Please select a Life Event below and complete the related form.
New Birth
Mother's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Father's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Baby's Name
First Name
Last Name
Baby's Date of Birth
-
Month
-
Day
Year
Date
Baby's Gender
Please Select
Boy
Girl
Hospital
Room No.
Hospital Phone No.
Hospitalization/Visitation
Member's Name
First Name
Last Name
Member's Phone
Please enter a valid phone number.
Contact's Name
First Name
Last Name
Contact's Phone
Please enter a valid phone number.
Member's Condition
Type of Surgery
Inpatient
Outpatient
Date of Surgery
-
Month
-
Day
Year
Where is he/she hospitalized?
Room No.
Hospital Phone Number
Please enter a valid phone number.
Additional Comments
Notification of Deceased
Name of the Deceased
First Name
Last Name
Is the deceased a member?
Yes
No
Is the deceased an immediate family member?
Father
Mother
Child
Sister
Brother
Grandparent
If not, what's their relation to you?
When did they transition?
-
Month
-
Day
Year
Date
Who are the funeral arrangements entrusted to?
What date is the funeral?
-
Month
-
Day
Year
Date
Where will the funeral be held?
Contact Person
First Name
Last Name
Phone Number
Please enter a valid phone number.
Please select if you're ONLY requesting a resolution from the church.
I am only requesting a resolution for the family
Additional Comments
Other Life Event
NOTE: IF YOU ARE IN AN EMERGENCY SITUATION PLEASE CALL 911. IF YOU ARE EXPERIENCING FINANCIAL HARDSHIP AND NEED ASSISTANCE, PLEASE CALL OUR OFFICE FOR DETAILS ABOUT THE BENEVOLENCE FORM FOR MEMBERS 251-725-1292.
Please explain other life event.
Submit
Should be Empty: