Memorial: Submit

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

Remember to make your donation to the Memorial Fund (account: 01-0235-0104533-50) with a reference to the fund and your name and also inform the Branch Treasurer

    Submitted by
    Name

    Email

    Phone (optional)


    Donation to the Memorial Fund ($)
    Details for entry in the Memorial Book

    Surname

    Christian names

    Date (or year) of death

    Enter the following details, as applicable

    Offices held (Branch)




    Offices held (Region)




    Offices held (Club)




    Honours bestowed




    Remembered by



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