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In Loving Memory
Please complete this form, for Bereaved Families of Ontario - South Central Region to post your loved one's name and completed information in the In Loving Memory section on the BFO-SCR website and in the quarterly newsletter.
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Email
*
Your email
Your First Name:
*
Your answer
Your Last Name:
*
Your answer
Name of Deceased:
*
Your answer
Please indicate - Child/Parent/Friend/Spouse/Partner of (as you would like it to appear):
*
Your answer
Siblings/Spouse/Partner/Family Members (as you would like it to appear):
Your answer
Date of Birth of Deceased:
MM
/
DD
/
YYYY
Date of Death:
*
MM
/
DD
/
YYYY
I give permission for this information provided to be posted on the Bereaved Families of Ontario - South Central Region website and in the quarterly newsletter.
*
Yes
No
I would like to sign up to receive the BFO-SCR quarterly newsletter and events/information updates:
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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