Memories of Me Memorial Form

Complete the information below to post a memorial. If you have any questions, or would like information on our Corporate or Club pages, please call (954) 252-2805 or e-mail sales@memoriesofme.com. You can also fax this form to (954) 894-0694. If you are unable to send your photographs electronically, follow the instructions and mail the pictures can be mailed to the following address:

Memories of Me.com
PO Box1374
Dania, FL 33004-1374

Memorial Information:
(This information will be placed in the memorial.)

Package	(required)
First name	(required)
Last name	(required)
Date of birth	(required)
Date of death	(required)
Resided	(city, state)
Occupation
Contact e-mail
Family/charity link
Sending photo(s)?		If yes, how?
Choose a song
Choose a background
Choose a plaque	(Diamond package only)
Survivors
Memorial

Your Information:
(This section contains contact information about you. The information entered here will not be displayed on the obituary.)

First name	(required)
Last name	(required)
Street address
Address (cont.)
City
State/province
Zip/postal code
Country
Phone
E-mail	(required)
Referred by	Specify
Password	(required for changes)
Site comments or suggestions

If you have problems using this form, please e-mail sales@memoriesofme.com or call (954) 252-2805 for assistance. You can also fax this form to (954) 894-0694.