Memorial Mailing List Registration
Please fill out the form below to register for our mailing list to receive updates and memorial information regarding recent passings in our organization.
Name of recently deceased
*
First Name
Last Name
Affiliation (Assembly) and/or Title (AB of Assembly, Grand Title, if applicable, etc)
*
Date of passing (mm/dd/yyyy)
Obituary link (if available)
Person submitting the form
*
First Name
Last Name
Email Address
*
example@example.com
Additional Comments or Requests
Submit
Should be Empty: