REQUEST A MEMORIAL AUTUMN LEAF

FOR YOUR CHILD

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Decide which graphic you would like for your child
then complete the form below the choices:






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REQUEST A MEMORIAL AUTUMN LEAF

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


Is your child's name already on the SEPTEMBER memorial page?
YES
NO

If you answered YES to the above question
PLEASE indicate ROW #:
(if you do not know the row #, please click your back button, return to the names page, find the row number that your child's name is already in)

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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(BEFORE CLICKING THE SUBMIT BUTTON, PLEASE BE SURE THAT ALL INFORMATION IS COMPLETE AND THAT ALL INFORMATION IS CORRECTLY SPELLED)











"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:
AUTUMN LEAVES