Custom Forms | Application for Entry in Book of Remembrance

Please provide the information requested below. Charges can be found on our website at: https://www.stratford-upon-avon.org/holy-trinity-hiring-charges

Contact Information

Name *

This is the person making the applocation who will be our main contact.

First name *

Please enter a First name

Middle name(s)

Surname *

Please enter Surname

Email *

Please enter a valid email

Home Phone

Please enter some text

Mobile

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Address

Address 1

Please enter some text

Address 2

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Address 3

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Town

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County

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Postcode

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Country

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Information Consent *

I agree to the Parish of Stratford-upon-Avon keeping me informed about news, activities and services in the Parish.

Yes

Please select at least one of the options

Details of the Entry to be made

Name of Deceased *

Please give the name as you want it to appear in the Entry

Please enter some text

Date of Birth *

Please enter a valid date

Date of Death *

Please enter a valid date

On which Date do you want the Entry to appear? *

Please select an option

Additional Information

The above data is used to create the basic entry on Lines 1 and 2. Do you wish the entry to contain further information (at extra cost)?

Yes - each extra line or illustration is charged

Line 3

Enter the text that you would like on Line 3 (up to 32 characters)

Please enter some text

Line 4

Enter the text that you would like on Line 4 (up to 32 characters)

Please enter some text

Line 5

Enter the text that you would like on Line 5 (up to 32 characters)

Please enter some text

Would you like an Illustration?

If 'yes' please answer the next question to describe the illustration that you would like.

Please select an option

Description for a Requested Illustration

In addition to a description please say whether you are sending a sample or photograph to guide the illustrator. If so, email it after completion of this form to [email protected].

Please enter some text

For Office Use only

Approved by

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Date of Approval

Please enter a valid date

Notes

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Calculated Charge

This is the basic charge plus the charges (all at current rates) for additional lines and/or an illustration.

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Date Applicant Advised of Charge and How to Pay

Please enter a valid date

Date Payment Received

Please enter a valid date

Date Applicant advised Entry can now be viewed

Please enter a valid date

By submitting this completed form you agree to our Privacy Policy which can be found on the Policies page of our website: https://www.stratford-upon-avon.org/holy-trinity-policies

Application for Entry in Book of Remembrance

Contact Information

Details of the Entry to be made

Additional Information

For Office Use only

Just sending that for you!

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Application for Entry in Book of Remembrance

Contact Information

Details of the Entry to be made

Additional Information

For Office Use only

Help Me

Some People Were Missed

Just sending that for you!

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