Funeral Request | Bethlehem Lutheran Church

We are sorry to learn of your loss. Please complete this form to help us gather some basic information. If there’s something you’d like us to know about you or your situation, please be sure to add a note in the additional information. We will respond to your request as soon as possible.

P: 585-223-0634
E: office@blcfairport.org

Bethlehem Lutheran Church Funeral/Memorial Request Form

Preferred Funeral Date(Required)

Full name of deceased(Required)

First Middle Last

Date of Birth(Required)

Date of Death(Required)

What was their relationship to BLC?(Required)

Member

Friend/Worshiper

Other

Primary Contact

Name(Required)

First Last

Relationship to deceased:(Required)

Your Address

Street Address Address Line 2 City ZIP Code

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Best Time to Call You(Required)

Is texting ok?

Yes

Are you working with a funeral home?(Required)

Yes

Which funeral home and name of contact person?(Required)

Additional Information:

CAPTCHA

Bethlehem Lutheran Church Funeral/Memorial Request Form

Primary Contact

Contact Information

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