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2018 Candlelight Memorial Event
Contact Information
Name
*
First Name
Last Name
Email
*
Address
*
Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
RSVP for "0" adults to have an event program mailed to you.
RSVP Adults (Age 16+)
*
select one
0
1
2
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10
RSVP Children (Ages 0-15)
*
select one
0
1
2
3
4
5
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9
10
1st Child's Name
Enter first, middle, and last names as they should appear in the program.
1st Child's Birth Date
(mm/dd/yyyy)
1st Child's Death Date
(mm/dd/yyyy)
Add a 2nd child?
Yes
2nd Child's Name
Enter first, middle, and last names as they should appear in the program.
2nd Child's Birth Date
(mm/dd/yyyy)
2nd Child's Death Date
(mm/dd/yyyy)
Add a 3rd child?
Yes
3rd Child's Name
Enter first, middle, and last names as they should appear in the program.
3rd Child's Birth Date
(mm/dd/yyyy)
3rd Child's Death Date
(mm/dd/yyyy)
Add a 4th child?
Yes
4th Child's Name
Enter first, middle, and last names as they should appear in the program.
4th Child's Birth Date
(mm/dd/yyyy)
4th Child's Death Date
(mm/dd/yyyy)
Add a 5th child?
Yes
5th Child's Name
Enter first, middle, and last names as they should appear in the program.
5th Child's Birth Date
(mm/dd/yyyy)
5th Child's Death Date
(mm/dd/yyyy)
