Form: Just Register Me!

Instructions:
To become a member of the Ohio Cremation & Memorial Society (OCMS), please fill out the form below, then click on the "Submit!" button. Note that items in BOLD are required.

Your Name:  
(First, Middle, Last)
Marital Status:  
Spouses Name:  
(If Wife, Give Maiden Name)
Residence Street & Number:  
City:  
Inside City Limits?  
State:  
County:  
ZIP Code:  
Phone Number:  
E-Mail:  
Social Security Number:  
Sex:  
Race:  
(Specify American Indian, Black, White, etc.)
Of Hispanic Origin?    If Yes, Specify: 
(If Yes, Specify Cuban, Mexican, Puerto Rican, etc.)
Date of Birth:  
Birthplace:  
(City and State / Foreign Country)
Father's Name:  
(First, Middle, Last)
Mother's MAIDEN Name:  
(First, Middle, Last)
Education:   Elementary (yrs):   College (yrs): 
Usual Occupation:  
(Give kind of work done during most of working life, do not use "Retired".)
Kind of Business/Industry:  
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:  

 

Options:   Please contact me by phone
   Please mail me a brochure
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