Cremation Society of Indiana
Indianapolis Indiana Cremation
Franklin Indiana Cremation
Pendleton Indiana Cremation
Shelbyville Indiana Cremation
Greenwood Indiana Cremation
Moorsville Indiana Cremation
Anderson Indiana Cremation
Carmel Indiana Cremation
Lawrence Indiana Cremation
Fishers Indiana Cremation
Brownsburg Indiana Cremation
Cumberland Indiana Cremation
Bargersville Indiana Cremation
Whiteland Indiana Cremation
Plainfield Indiana Cremation
Muncie Indiana Cremation
Kokomo Indiana Cremation
Lafayette Indiana Cremation
Bloomington Indiana Cremation
Columbus Indiana Cremation
Batesville Indiana Cremation
ABOUT US
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MEMBERSHIP FORM
Yes, I want to become a lifetime member.
Individual Membership - $35 one-time fee.
Couple Membership - $50 one-time fee.
I am interested in pre-planning my arrangements. Please have someone contact me.
Personal Information
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AKA Name
Sex
Male
Female
Ethnic Background
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African-American
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Other
D.O.B.
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Lived in U.S. since
Spouse and Parent Information
Surviving Spouse:
Spouse First Name
Middle Initial
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Name of Father:
First Name
Middle Initial
Last Name
Father’s Birth US State or Country
Is your father still living?
Yes
No
Name of Mother:
First Name
Middle Initial
Last Name
Mother’s Birth US State or Country
Is your father still living?
Yes
No
2nd Member’s Spouse Information
Name
AKA Name
Sex
Male
Female
Ethnic Background
Caucasian
African-American
Hispanic
Asian/Pacific Islander
American Indian
Other
D.O.B.
US State or Country of Birth
Social Security Number
Marital Status
Married
Never Married
Widowed
Profession/Occupation
Years in Occupation
Military Service
Yes
No
Branch
Service Number
Date of Enlistment
Date of Discharge
Lived in U.S. since
2nd Member’s Spouse and Parent Information
Surviving Spouse:
Spouse First Name
Middle Initial
Last or Maiden Name
Name of Father:
First Name
Middle Initial
Last Name
Father’s Birth US State or Country
Is your father still living?
Yes
No
Name of Mother:
First Name
Middle Initial
Last Name
Mother’s Birth US State or Country
Is your father still living?
Yes
No
Legal Residence
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Next of Kin or Persons in Charge of Your Affairs
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State
Phone
Cell Phone
E-mail Address
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Relationship
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City
State
Phone
Cell Phone
E-mail Address
Name
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CVV2
What is CVV2?