Obituary Form

Obituary Form

Please fill out the following information to create an obituary.
Your Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Deceased's Name*
Deceased's Age*
Was he/she a JSGA member?*

YesNo
Related JSGA Member's Name
Relationship of deceased to the JSGA Member
e.g. If the deceased is father of the member then enter "Father"
Place of Death*
Date of Death*

MonthDayYear
Date
Survived By (e.g. son , daugther, grandson etc.)
Funeral Date

MonthDayYear
Date
Funeral Time

Hour Minutes

AM/PM Option
Funeral Duration (in hours)
Funeral Location (Address)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Prayer Date

MonthDayYear
Date
Prayer Time

Hour Minutes

AM/PM Option
Prayer Location
Upload Photo of Deceased

Cancelof
Should be Empty: