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

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Mobile

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Address

Address 1

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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

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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? *

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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)

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Line 4

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

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Line 5

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

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Would you like an Illustration?

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

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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].

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For Office Use only

Approved by

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Date of Approval

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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

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Date Payment Received

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Date Applicant advised Entry can now be viewed

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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