REQUEST A MEMORIAL PUMPKIN
for your child

page 3 of 3

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

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REQUEST A MEMORIAL PUMPKIN

Please complete the form below (items 1 - 7) and be sure to click on the SUBMIT button at the end of the form: (in the white typing boxes you may continue typing after the boxes appear full)

1. MEMORIAL PAGE
Is your child's name already on the OCTOBER memorial page?
YES
NO

2. ROW
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)

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

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

5. AGE
Child's age at death?

6. CHOICE
CHOOSE by completing steps a b c:

a- See the graphics in the CHOICES section above this form.

b- Decide which graphic you would like for your child.

c- In the list BELOW, click on the number of the graphic you have chosen.

Click on your CHOICE:

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(Before clicking the submit button, please be sure that all information is complete and correctly spelled)

7. SUBMIT
Click on the SUBMIT button below. If your submission was recorded you should see a THANK YOU page when you click the submit button. If you do not see a THANK YOU page then you need to re-enter your information When your child's name is placed you will be notified by the email address that you provided.
CLICK SUBMIT BUTTON NOW:

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:
MOONLIGHT