Pre-Planning Form | Cremation Society of New England

Thank you for your interest in the Cremation Society of New England. Please complete the following form to begin the pre-planning process. Once we have received your information, store the information in our computers so that is on on record at a time of need. If you indicate you would like to pre-fund your services, we will send you the appropriate paperwork to establish a pre-funded funeral trust.The information provided below should be for the member (the person whose cremation we will be facilitating). If you are filling out this form for someone else, it is their information (not your own) that you should be providing.

Membership Form

I am planning for:

Name (First Middle Last):

Email Address:

Address:

City:

State/Province:

Country:

Zip Code:

Phone Number:

Place of Birth:

Date of Birth:

Sex:

Citizenship:

Marital Status:

Spouse (Maiden Name):

Father's Name:

Mother's First and Maiden Name:

SSN:

Education

Highest Level Completed:

Family Information: Please list the names of survivors and state their relationship to you, their spouse's names and the city in which they live as you wish to have them listed in the memorial. (The following is a guide to assist you.) SURVIVORS: Spouse, Sons, Daughters, Parents, Brothers, Sisters, Grandchildren, (Great-grandchildren), Grandparents, Others (Eg. Son: Joe Smith and his wife Paula of Milledgeville)

Survivors::

Preceded in Death by::

Additional Information (Optional):

Work History

Occupation:

Business:

Industry:

Company:

Number of Years:

Years Retired:

Work History

Service Branch:

Serial Number:

Date Enlisted:

Rank at Discharge:

Date Discharged:

Discharge on File At:

Combat Action:

Memorial Service Preferences

Do you wish to have a memorial service?

YesNo

Do you wish to have a private family visitation/viewing?

YesNo

I prefer

A simple cremation with no view

A private family viewing followe

Cremation memorial service

Cremation graveside service

I wish to pay in advance:

If you are completing this form for someone else:

Your Name:

Your Address:

Your City:

Your State:

Your Zip:

Your Phone:

Your Email:

Choose One:

Designated Recipient of Ashes:

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