Pre-Plan | Chicago Chapter National Black Nurses Association Inc. | Chicago Illinois

PRE-PLANNING

Most of us plan ahead in life. We plan for our wedding, our children’s education, family vacations, and other significant expected life events. We also plan for the unexpected events of life by purchasing home, auto and medical insurance.

Understanding the benefits of planning ahead has prompted many to take the step to plan their own arrangements.

In Person – Please Contact Us to set up an appointment to discuss planning ahead with a caring professional.

Online – To begin pre-planning on-line, please fill out our Online Pre-planning Form. A member of our staff will contact you after your submit your form

Name

Email Address

Phone Number

Address (Street, City, State, Zip Code)

County

Birth Date

Birth Place (City & State)

Occupation

Marital Status

If married, Date & Place of Marriage

Spouse (Wife's Maiden Name)

Physician

Years of Education

Veteran? (Branch of Service)

Father's Name

Mother's Name (Maiden Name)

Next of Kin (Relationship)

Next of Kin Address & Phone Number

Place of Service

Clergy

Graveside By

Music (Requests, Vocalist, Musician)

Visitation (Public or Private)

Type of Disposition & Place of Disposition

Block

Lot/Section/Tier

Grave(s)

City & State

Casket/Cremation Container

Outer Burial Container/Urn

Bearers

Surviving Relatives (Name, Relationship, City & State)

Biographical Information (Details of life, career, church, organization membership, etc.)

Insurance

Personal Request (Clothing, Jewels, Flowers, Memorial Contributions, Etc.)

15 + 3 =

Chicago Chapter National Black Nurses Association Inc.

P.O. Box 4612 Chicago Illinois 60680 | Phone: 312-471-8908
© Chicago Chapter National Black Nurses Association Inc | site by: MEDICAL DIVISION of articdesigns.com | EmailLOGIN