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REQUEST A MEMORIAL VALENTINE

for your child...... page 4 of 4

music playing: BEAUTIFUL TIMES

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REQUEST A MEMORIAL VALENTINE

Please complete the form below: (in the white typing boxes you may continue typing after the boxes appear full)

Your email address?
(please make sure that the email address you entered is typed correctly)

Child's full name?
(Name will be added exactly as entered, so please check spelling and capitalization)

Child's age at death?

CHOOSE by completing steps 1 - 4:

1. See the graphics in the CHOICES section above this form.

2. Decide which graphic you would like for your child.

3. In the list BELOW, click on the name of the graphic you have chosen.

4. CLICK on the submit button at the end of this list below.

5. When your child's name is placed you will be notified by the email address that you provided.

Click on your CHOICE:

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You may contact Christine at:
ChristineRoss01@msn.com

"VISIT WITH LUKE"

Last Entry in Luke's Journal:

"When there is love in my heart and a smile on my face,
I need nothing else." ~ Luke Ross

"MAY THE FORCE BE WITH YOU"

Music playing:
BEAUTIFUL TIMES