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2022 - 2023 Deceased Members
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* Indicates required question
Name of Deceased Member
*
Your answer
Membership ID Number
if known
Your answer
Member's Unit Name and Number
*
Your answer
Member's District
*
Your answer
Member's Division
*
Your answer
Date of Death
*
Your answer
Member Status
*
Senior
Junior
Gold Star Member
Charter Member
PUFL Member
Required
Next of Kin
Please advise where sympathy cards should be sent
Your answer
Relationship to Deceased
Your answer
Address
Your answer
City, State Zip
Your answer
Name of Chaplain submitting this form
*
Your answer
Telephone Number of Chaplain
*
Your answer
e-mail address of Chaplain
Your answer
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