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.

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 *


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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