Membership Form

If you're interested in becoming a Member of Kansas Cremation Services, please complete the following form. The charge for the Membership is a one-time fee of $45, which will be refunded if you enter into a funded pre-arrangement with Kansas Cremation Services.

Registrant:
 
First Name
Middle Name:
Last Name:
E-Mail:
Street Address:
Apt/Suite:
City:
State:
ZIP Code: -
Social Security Number:
Date of Birth:
Telephone Number:
 
Next Of Kin:
 
Name:
Relationship:
Street Address:
Apt/Suite:
City:
State:
ZIP Code:
Phone:
 

Email info@kansascremation.com