Legacy Page Creation Request

First Name

Last Name

Phone

Relationship to the Deceased

Name of the Deceased

Date of birth

Date of passing

Tell us a little about their stomach cancer journey.

What were their greatest achievements? (i.e. professional, personal, social)

Tell us about their favorite poem, author, or words to live by that most exemplified your loved one.

Thank you for the opportunity to honor your loved one's legacy. We will reach out to you shortly, via email, to request 3 to 4 photos to be used on your loved one's Legacy Page.

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Legacy Page Creation Request