RSM Funeral Announcement Submission Form

Personal Info

Name of deceased *

First

Last

Name Pronunciation

Age *

Address *

Formerly Of *

Date of Death

Date of Death *//

Location of Death *

Immediate Survivors *

Predeceased by *

Funeral Arrangements (Check all that apply) *

If Other, please describe *

Service Date

Service Date / Time *

//Date

Time

Service Location *

Funeral Service Details

Choose One *

Burial
Ash interment

Burial or Ash Interment Location

Prayer Service *

Prayer Service Date and Time *

//Date

Time

Prayer Service Location *

Viewing *

Viewing Date and Time *

//Date

Time

Viewing Location *

Viewing Prior to the Service *

Viewing Prior to the Service Location *

Donations can be made to

Donations can be made to a charity of one’s choice

Donations can be made to a charity of one’s choice

Funeral Home in charge of arrangements *

Contact Info

Your Name *

First

Last

Your Phone Number *

Your Email *

Email

Confirm Email

Billing

The cost per announcement is $25.00 + GST per day.

After submitting this form, you will be redirected to PayPal. You can pay with your PayPal account or credit card.

Once your payment has been received, your announcement will be aired on CFAM Radio 950, AM1250 Radio and CJRB Radio 1220. It will also be posted on PembinaValleyOnline.com, SteinbachOnline.com and DiscoverWestman.com.

Times to Air *

Dates you wish your announcement to air *

Announcement Photo (Optional)

Consent *

I agree to allow PembinaValleyOnline.com to contact me using this information. View Privacy details.

Total Amount

$ 0.00

Stripe Credit Card *

Card

Name on Card