Last Wishes Form

SECTION 1: First Name *

Current email address *

So we can send you a printed copy of your information

Last Name *

Current mailing address *

So we can mail you a printed copy of your information.

Date of Birth

Please enter month day and year. You can just type it in, ignoring the date choices.

Birth place (City and State)

Mother's name

Father's name

Additional relatives (with relationship) please list each on separate line

Education

Career

Awards

organizations

interests/activities

History of Quaker Involvement

Other information

SECTION 2: Wishes for a Memorial Meeting

Memorial Meeting Location

If you have selected a location other than the FMSA Meetinghouse, please give details on the other location.

Which of the following would you like at your Memorial Meeting for Worship (check all desired)

Which of the following do you desire? (check all desired)*

Memorial plaque in location determined by the property committee
Cremains interred (ashes buried) on FMSA grounds (limited locations)
Cremains scattered on FMSA grounds (no restrictions)
A Memorial planting with or without plaque
other

Details from above

*Note expenses are your estate's responsibility

Other instructions or wishes regarding your Memorial Meeting for Worship

SECTION 3: People for Meeting to Notify about your Death. This information is useful to the Meeting, if you do not have family members or your executor in the local area.

Name 1

Street Address 1

City and State 1

Email 1

Enter the personal relationship for the first person from the dropdown

Phone number 1

Additional notes 1

Name 2

Street Address 2

City and State 2

Email 2

Enter the personal relationship for the second person from the dropdown

Phone number 2

Additional notes 2

Name 3

Street Address 3

City and State 3

Email 3

Enter the personal relationship for the third person from the dropdown

Phone number 3

Additional notes 3

comments (if there are multiple persons to contact, potentially, please continue them in this space)

Last Wishes Form

Please fill out the following information. You may leave items blank, if you wish.

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