Memorial Wall Request Form

HVUUC Memorial Wall Request Form
INFORMATION FOR MEMORIAL WALL
It is the custom of HVUUC to memorialize deceased members by carving their names on our Memorial Wall. If you would like to have someone’s name inscribed on our Memorial Wall, please complete this form. The names of past members and long-term friends can be added with approval of the Board of Trustees.

In the box below, carefully type the name of the deceased exactly as it is to be carved in stone.

Note: Our practice is to carve a first and last name, with the year of birth and year of death. In the case of nicknames, we suggest using whatever name was most commonly used at HVUUC. Please do not use prefixes or suffixes that are generational (Jr. Sr.), academic (Dr., Ph.D.), military or honorary.
Name

First NameLast Name
Dates

Year of BirthYear of Death
If you wish to retain space near the deceased’s name for a spouse/other, please provide the spouse/other’s name so we can leave the appropriate space:
Spouse's Name

First NameLast Name
Year of birth
Name of person making this request: First Name Last Name
Signature of person making this request: Signature
Relationship to deceased
Telephone number of requestor
Please enter a valid phone number.
Email of requestor
example@example.com
The cost of inscribing a name is approximately $200. HVUUC does not require a donation to cover this expense, although it is appreciated. To donate, make checks payable to HVUUC with the notation, “Memorial Wall Fund” on the note line, and mail to HVUUC, PO Box 8383, Gray TN 37615 or place in the offering plate.
Should be Empty:

HVUUC Memorial Wall Request Form