Benevolent Form - Family Sympathy and Loss

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Members are eligible to receive flowers or a donation can be made to charitable organization with a maximum value of $185.00. This includes:
- a spouse
- a child (including step children)
- a grandchild
- a parent (including step parents, legal guardian, parent in-law)
- a sibling (including sibling in-law)

- aunt or uncle

- grandparent

To be eligible, the form must be submitted within 2 months of the event.

Email *

What is your first and last name? *

What is the first and last name of the local member who has lost a family member? *

Please identify which family member: *

Spouse

Child / Stepchild

Grandchild

Parent (Step-Parent or Legal Guardian)

Parent in-law

Grandparent

Sibling

Sibling in-law

Aunt/Uncle

What is the first and last name of the deceased? *

Please provide the date of death. *

YYYY

Please provide the details or url of obituary *

Would you like to send one (1) of the following? *

send member flowers

send member a living plant

make a donation to charitable organization in memory of the deceased ($185.00)

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