Minnesota Cremation & Memorial Society - caskets, cremation, cemteries, funerals, urns.

To become a member of the Minnesota Cremation & Memorial Society, simply complete this form. You are a member of the Minnesota Cremation & Memorial Society when this form is received. Within a few days, you will receive your wallet-size membership ID card. Please note that the information on this form is kept strictly confidential.

First Name:
Middle Name:
Last Name:
Address:
City:
State:
ZIP Code:	-
E-Mail:
Date of Birth:
Place of Birth:
Sex:	Male Female
Phone:
Social Security Number:
Education (Years Completed):
Marital Status:
Race:
I am a U.S. Veteran:
Occupation (Present or Before Retirement):
Employer:
Name of Spouse - First:
Name of Spouse - Last/Maiden Name:
Check if deceased:
Name of Father - First:
Name of Father - Last Name:
Check if deceased:
Name of Mother - First:
Name of Mother - Maiden Name:
Check if deceased:
Please include any additional information you would like to be included in an obituary notice such as names of family members, organizations, activities, educational background and employment history:

Authorization for Custody, Cremation and Final Disposition
By submitting this form, I hereby authorize and request the Minnesota Cremation & Memorial Society, in accordance with its rules and regulations, and any applicable laws or regulations, to take possession of, to cremate and to carry out the final disposition of my remains as instructed below.
Please check one of the following options:
Hand deliver cremated remains to the following individual: Ship cremated remains to the following individual: Hand deliver cremated remains to the following cemetery: Ship cremated remains to the following cemetery:
Please fill out the following contact information:
Name of Individual or Cemetery:
Street Address:
City:
State:
Zip:
Cemetery Lot # or Niche # [If Applicable]
By submitting this form I indicate I have read and fully understand this document. Whoever is responsible for my final disposition must carry out my legally binding wishes as set forth in this document in which I have made known my full intentions.