Memorial Request Form Entry

MEMORIAL REQUEST

We are so sorry for your loss and pray for peace and comfort for you and your loved ones. Please fill out the form below if you are interested in hosting a service for your loved one at our campus. The request will then be reviewed and approved, and someone from our staff will reach out to you. May Jesus’ peace be with you.

Primary Contact First Name

Primary Contact Last Name

Primary Contact Relationship to Deceased

Primary Contact Mobile Phone

Primary Contact Home Phone

Primary Contact Email Address

Primary Contact Connection to Central

Deceased First Name

Deceased Last Name

Deceased Date Of Death

Services Being Requested

Funeral Memorial Service Viewing Reception

Campus

Approximate Attendance

Requested Date and Time

Do you need a pastor to officiate?

Submit