Personal Preferences - Form - Temple Beth Shalom

The purpose of this form is to help alleviate stress on family members when making funeral arrangements. We ask that you indicate your current preferences; we understand that these wishes can be changed at any time.

* Full Legal Name Including Middle Name

* Phone Number

Email Address

* Preferred English Name

* Hebrew Name

Mother's Name

* Mother's Hebrew Name

Father's Name

* Father's Hebrew Name

* Name of primary family member or friend to coordinate all arrangements

* Contact info of primary family member or friend to coordinate all arrangements

Please list any powers of attorney here

Place of Birth

Birth Date

SSN (optional; it will be required for the funeral home)

Occupation

Education (highest grade)

Are you a military veteran?

Please Select OneYesNo

Would you like an honor guard at the funeral?

Please Select OneYesNo

If selected other for burial, please describe.

Please elaborate if appropriate

If you are being buried at a gravesite, please give as much information as possible here. For example, where the site is located or if one has been purchased yet.

Please list the names of any preferred clergy members here.

Would you like the service to be public or private?

Please list the names of anyone you would like to give a eulogy.

Names of any preferred pallbearers

Please list any specific requests for the service (ie: readings, poems, prayers)?

Please check any/all of the following traditional Jewish rituals you would like performed.

Taharah (ritual purification performed by Chevra Kadisha)Shmirah (sitting with me until burial)use a plain "Kosher" casketto be wrapped in a tallit

If you would like to be wrapped in a tallit, do you have one or would you like one provided?

My preference for a grave marker is

granitewith bronze plaqueslantedupright

Please specify any symbols you would like on the marker

Please specify any text you would like on the marker.

I would like donations in my memory made to

Please include the following details in my obituary

Include a photograph?

Please provide my obituary to the following newspapers

Other wishes

Would you like to be contacted about any of the following options? Please check all that apply.

Purchasing a yahrzeit plaque for the Memorial Wall in our sanctuaryPurchasing a cemetery plot in the Temple Beth Shalom section of the Austin Memorial CemeteryOpportunities to support Temple Beth Shalom's future through an endowment or bequeathal