PC(USA) - PW: Celebrate the life of a Presbyterian woman



				Celebrate the life of a Presbyterian woman * indicates required information

	Information about deceased			Name: *


				Age: *


				Date and location of death: *


				City of residence (if different than location of death):


				State of residence (if different than location of death):


				Church: *


				City in which church is located: *


				State in which church is located: *


				Presbytery:


				Church involvement (150 word limit): *


				Names of surviving family:


				Do you have an electronic photo of the deceased? (We will contact you with instructions for submitting the photo.) *
				Yes No

	About You			Your name: *


				Mailing address: *


				City: *


				State: *


				Postal code: *


				Telephone number: *


				Email address: *

Celebrate the life of a Presbyterian woman