Internet Cremation Society Participant Virginia

Membership Registration Form for the Cremation Society of Virginia


To become a member of the Cremation Society of Virginia, simply complete this form along with your credit card information. The fee for registration is $25. You are a member of the Cremation Society of Virginia when this form is received. Within a few days, you will receive your wallet-size membership ID card. Please note that the information on this form is kept strictly confidential.

First Name:
Middle Name:
Last Name:
Address:
City:
State:
ZIP Code:-
E-Mail:
Sex:Male
Female
Phone:
Social Security Number:
Education (Years Completed):
Ancestry:
Race:
  • I am a U.S. Veteran:
    • Occupation (Present or Before Retirement):
    Employer:
    Name of Spouse - First:
    Name of Spouse - Last/Maiden Name:
  • Check if deceased:
    • Name of Father - First:
    Name of Father - Last Name:
  • Check if deceased:
    • Name of Mother - First:
    Name of Mother - Maiden Name:
  • Check if deceased:
    • Please include any additional information you would like to be included in an obituary notice such as names of family members, organizations, activities, educational background and employment history:
    AUTHORIZATION FOR CUSTODY, CREMATION AND FINAL DISPOSITION
    By submitting this form, I hereby authorize and request the Cremation Society of Virginia, in accordance with its rules and regulations, and any applicable laws or regulations, to take possession of, to cremate and to carry out the final disposition of my remains as instructed below.
    Please check one of the following options:
      Release cremated remains to the following individual:
      Hand deliver cremated remains to the following individual:
      Ship cremated remains to the following individual:
      Hand deliver cremated remains to the following cemetery:
      Ship cremated remains to the following cemetery:
      Please have the Cremation Society of Virginia arrange for the following scattering option:
    Please fill out the following information:
    Name of Individual or Cemetery:
    Street Address:
    City, State, Zip:
    Cemetery Lot # or Niche # [If Applicable]
    Scattering Option [If Applicable]
    By submitting this form I indicate I have read and fully understand this document. Whoever is responsible for my final disposition must carry out my legally binding wishes as set forth in this document in which I have made known my full intentions.

    Billing Information We accept Visa and Mastercard
    Card Number:
    Expiration Date (mm/yy): 

    Billing Address (if different than listed above):
    Address:
    City:
    State:
    Zip Code:-

      


    Back to Virginia's Home


    [ Main Page | Cremation Societies | Urnmall ]
    [ Scattering Services | Obituary Sites | Caskets Online ]
    [ Cremation bookstore | Attention Vendors | Cremation Information ]