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Emmanuel Church at Brook Hill

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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

First name*

Last name*

Relationship to Deceased*

Address*

Phone*

Email*

Are you a member of Emmanuel Church?*

Yes

No

Memorial Information

Please upload a copy of the obituary, if possible

Full Name of the Deceased*

Name to be engraved (if different from above)

Date of Birth*

Month

Day

Year

Date of Death*

Month

Day

Year

Was this person a member (or a past member) of Emmanuel Church?*

Yes

No

Cemetery of Interment (if applicable)

Cemetery Address

Other Information

Father of the Deceased

Mother of the Deceased

Children of the Deceased

Is there anything else you would like us to know?

Emmanuel Episcopal Church
at Brook Hill

(804) 266-2431

church@emmanuelrva.org

1214 Wilmer Avenue

Richmond, VA 23227

Write Us

Thanks for submitting!

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