Memorial Service Planning Form

Name of Primary Contact for Memorial Service

Email of primary contact

This address will receive a confirmation email

Best Phone Number for primary contact

Name and contact info for any secondary contact or other survivors the minister should know about.

About the Deceased

Name of deceased as it should be printed in an Order of Service

Date of Birth

Date of Death

What pronouns did they use?

Military honors? Please share details here - branch, division, rank, etc.

If a member of Countryside Church UU, what were they involved in at the church?

What else should we know? (sexual orientaiton, gender identity, disabilities, other identity topics, 12-step, etc.)

Is there anything our minister should know about family relations, cause of death, or other circumstances which would impact planning this memorial?

Are there any surprises you expect during the service - or people who are greatly unresolved about this death?

Obituary (if applicable)

Memorial Planning

Date of memorial service (if confirmed by church and/or minister)

Approximately how many people do you anticipate will attend the service?

Online participation:

I would like the service livestreamed on the church channel I would not like the service livesteamed other (include in comments below)

Names of 2-3 people who might speak during the service (each person speaks for 3-5 minutes - 300-500 words)

Eulogy/an outline of the deceased's life and who they were

I would like the minister to deliver the eulogy. A family member will deliver the eulogy.

The pianist typically plays a prelude, interlude, and postlude. Request pieces or styles here:

Readings Requested (choose 0-2)

Psalm 23 All Souls by May Sarton In Blackwater Woods by Mary Oliver They Are With Us Still by Kathleen McTigue We Remember Them, Rabbi Roland B. Gittelsohn No readings, please Other (please include in comments below)

Hymns Requested (choose 0-3)

#16 Tis a Gift to be Simple #21 For the Beauty of the Earth #108 My Life Flows on in Endless Song (How Can I Keep From Singing) #123 Spirit of Life #126 Come Thou Fount of Every Blessing #1002 Comfort Me #1009 Meditation on Breathing No hymns, please Other (please add in comments below)

Comments, questions, requests:

Burial/Cremation

I would like the minister to officiate at a graveside service I would like the minister to officiate at a cremation I would like the minister to officiate at a scattering of ashes The family will handle the disposition of the body without the minister.

If working with a funeral home, list the funeral home here:

Memorial Service Planning Form

Description

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