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Personal Preferences
Please verify reCaptcha before submitting the form.
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
*
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 One
Yes
No
Would you like an honor guard at the funeral?
Please Select One
Yes
No
*
I would like to (select all that apply)
Be buried in cemetery
Be placed in a mausoleum
Donate my body/organs
Be cremated
Other- more detail
If selected other for burial, please describe.
*
I would like my funeral service held
Please Select One
At graveside
At funeral home
I have pre-arranged my funeral with someone- please elaborate
Other
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" casket
to 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
granite
with bronze plaque
slanted
upright
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 sanctuary
Purchasing a cemetery plot in the Temple Beth Shalom section of the Austin Memorial Cemetery
Opportunities to support Temple Beth Shalom's future through an endowment or bequeathal
Tue, May 24 2022 23 Iyar 5782