Memorial Book: Form

Submit an entry for the Memorial Book

A request for an entry in the Memorial Book may be submitted online by completing the form below. The form will be emailed to the Branch Secretary with a copy to yourself.
Please note that the online form for requesting an entry in the Memorial Book will not display fully on the screen that you are using. Please use a device with a wider screen (minimum 651px) if you wish to submit an entry online.

Alternatively, the form may be downloaded and completed offline by clicking

Please remember to send your donation to the Memorial Fund to either the Secretary or the Treasurer of NZ Branch.

Submitted by
Name
Email
Phone
Donation to the Memorial Fund ($)
Details for entry in the Memorial Book
Surname
Christian names
Date (or year) of death

Offices held (Branch)

Offices held (Region)

Offices held (Club)

Honours bestowed

Remembered by

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