Interdenominational Infant Memorial Service Registration

 

7pm, May 12th, 2018

Truro Anglican Church

 

Fill out the form below to register.  There is no cost to attend.  If you would like to sponsor the event for a donation of 

 

Note: Persons at different addresses should register separately. Households can register together.

If your spouse/children are also attending, what is/are their name(s)?
The nam(es) of the child(ren) you are honoring (optional - we will use Baby [Your Last Name] if no name is given)
Text to appear on a certificate of life that acknowledging the baby's human dignity: (Ex 1: I, Chaney Mullins, honor Sam Mullins, my brother lost to miscarriage. Ex 2: In honor of the life of my grandchild Baby Jones, child of Betsy Jones.)*
How did you hear about the memorial service? (select all that apply)*
  • Tepeyac OB/GYN
  • Personal Friends and Family
  • A Past Service Attendee
  • My Church
  • The Arlington Catholic Herald
  • An Online Events Calendar
  • The Anglican Life Ministries Network
  • The Pregnancy Support Network
  • The Arlington Diocese
  • Not Sure/Not Applicable/Other
  • Divine Mercy Care Emails
  • Mailed Invitation
  • Social Media
Any special requests? (such as reception dietary restrictions; if you would like to be called up at the same time as your friend attending the service)

 

Country
State / Province*
Address
City
Email*
Confirm Email*
Phone*
Additional Comments

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