Cremation Society of South Carolina

CREMATION SOCIETY OF SOUTH CAROLINA
328 Dupont Drive Greenville, SC 29607 864.233.7334 Toll free 877.322.7368

Membership Form
The cost for membership is $25.00 per member. For the membership process to be completed, you will have to mail a check, money order, or credit card information along with your pre-need authorization form.

DEATH CERTIFICATE INFORMATION


First Name:
Middle Name:
Last Name:
Phone:
Address:
City:
State:
Zip:
Email:
Social Security Number:
Date of birth:
Birthplace City:
Birthplace State:
Birthplace Country:
U.S. Armed Forces (if yes, please enclose a copy of discharge papers):yes no
Branch of Service:
Rank:
Marital Status:
Spouse’s First Name:
Spouse’s Middle Name:
Spouse’s Last or Maiden Name:
Usual Occupation:
Type of business:
Employer:
How Long:
Education (highest grade completed including college):
Race
Father’s First Name:
Father’s Middle Name:
Father’s Last Name:
Father Deceased:
Mother’s First Name:
Mother’s Middle Name:
Mother’s Maiden Name:
Mother Deceased:

OBITUARY INFORMATION

Children and their places of residence (indicate deceased) (separate by commas):
Grandchildren and their places of residence (indicate deceased) (separate by commas):
Siblings and their places of residence (indicate deceased) (separate by commas):
Wedding Date:
Religious affiliation/ church:
Organizations (Clubs, memberships, lodges, societies, fraternities, sororities):
War Record:
Would you like pre-funding information?
	yes no

You may include payment for your cremation services with your registration fee, or pay for cremation services at any time in the future. You are a member when we receive this form and your registration fee of $25.00, Registration fees are non-refundable. Please use one form per member.