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Cemetery 6.JPEG

Memorial Request Form

Fill out the form below for each brick or bench you would like to request. Please note: the submission deadline is Monday, September 16, 2024.

I am requesting a
Memorial Brick ($40)
Memorial Bench ($500)

Requester Information

Are you a member of Emmanuel Church?
Yes
No

Memorial Information

Date of Birth
Date of Death
Was this person a member (or a past member) of Emmanuel Church?
Yes
No

Other Information

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