Celebration of Life Resource Package Request Form

Celebration of Life Resource Package Request Form
Name of Requester*

First NameLast Name
Organization Name (If applicable)
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.
Family Name of Bereaved *
Who is the service for?*

First NameLast Name
Date of Service*

MonthDayYear
Date
Location of the Service*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Package Types:

50 Attendees
- 20 'About Us' Brochures
- 30 Resource Guides
- 5 'Remember' Bumper Stickers
- 50 'Remember' Wristbands
- 25 'Hope' Stones
- 25 'Remember' Stickers
100 Attendees
- 20 'About Us' Brochures
- 30 Resource Guides
- 5 'Remember' Bumper Stickers
- 100 'Remember' Wristbands
- 50 'Hope' Stones
- 50 'Remember' Stickers
200 Attendees
- 20 'About Us' Brochures
- 30 Resource Guides
- 5 'Remember' Bumper Stickers
- 150 'Remember' Wristbands
- 100 'Hope' Stones
- 100 'Remember' Stickers
Package type requested:*

50 attendees100 attendees200 attendees
Optional Donation (donations are strongly encouraged for requesting organizations)
prevnext( X )
50 Attendees
$115.00 Quantity



100 Attendees
$205.00 Quantity



Covers 200 attendees
$360.00 Quantity



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty: