Form: Register Me and My Spouse!

Instructions:
Use this form to register you and your spouse for membership in the Ohio Cremation & Memorial Society (OCMS). Note that this is a three part form, Section I is about you and your spouse, Section II is about just you and Section III is about your spouse. Note that items in BOLD are required.

When finished, please click on the "Submit!" button.


 Section I - Information about you and your spouse
 
Residence Street & Number:  
City:  
Inside City Limits?  
County:  
State:  
ZIP Code:  
E-Mail:  
Phone Number:  

 


 Section II - Information about you only
 
Your Name:  
(First, Middle, Last -- If Wife, Give Maiden Name)
Sex:  
Social Security Number:  
Date of Birth:  
Birthplace:  
(City and State / Foreign Country)
Usual Occupation:  
(Give kind of work done during most of working life, do not use "Retired".)
Kind of Business/Industry:  
Of Hispanic Origin?    If Yes, Specify: 
(If Yes, Specify Cuban, Mexican, Puerto Rican, etc.)
Race:  
(Specify American Indian, Black, White, etc.)
Education:   Elementary (yrs):   College (yrs): 
Father's Name:  
(First, Middle, Last)
Mother's MAIDEN Name:  
(First, Middle, Last)
Ever in U.S. Armed Forces?  
Date of Entry:  
Place of Entry:  
Date of Discharge:  
Place of Discharge:  
Serial Number:  
Rank:  
Branch of Service:  
If you are receiving retirement or disability pay, enter claim number here:  

 


 Section III - Information your spouse only
 
Spouses Name:  
(First, Middle, Last -- If Wife, Give Maiden Name)
Sex:  
Social Security Number:  
Date of Birth:  
Birthplace:  
(City and State / Foreign Country)
Usual Occupation:  
(Give kind of work done during most of working life, do not use "Retired".)
Kind of Business/Industry:  
Of Hispanic Origin?    If Yes, Specify: 
(If Yes, Specify Cuban, Mexican, Puerto Rican, etc.)
Race:  
(Specify American Indian, Black, White, etc.)
Education:   Elementary (yrs):   College (yrs): 
Father's Name:  
(First, Middle, Last)
Mother's MAIDEN Name:  
(First, Middle, Last)
Ever in U.S. Armed Forces?  
Date of Entry:  
Place of Entry:  
Date of Discharge:  
Place of Discharge:  
Serial Number:  
Rank:  
Branch of Service:  
If you are receiving retirement or disability pay, enter claim number here:  

 

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