Start a Memorial - Guardian -
MY CONTACT DETAILS
Name
:
Address Line1
:
Address Line2
:
City
:
State
:
ZIP
:
Country
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Daytime Telephone
:
Extension :
Cell
:
e-mail
:
Relationship to Decedent:
:
Caregiver
Spouse/Partner
Sibling
Child
Other family (Please Describe)
:
DECEDENT INFORMATION
Name
:
Date of birth
:
Year
1900
1901
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Month
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Place of birth
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City
State
Country
Name of parents
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Father
:
Mother (maiden name)
:
Name of Surviving Spouse/Partner
:
Names of Children Living
:
Names of Grandchildren-Living
:
Names of Siblings Living
:
Date Diagnosed with Parkinson's (ism)
:
Year
1900
1901
1902
1903
1904
1905
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1907
1908
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1910
1911
1912
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1990
1991
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2004
2005
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2007
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2010
Month
Jan
Feb
March
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May
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Dec
Day
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Date of death
:
Year
1900
1901
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1907
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1910
1911
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1914
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1950
1951
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1954
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1958
1959
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1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Month
Jan
Feb
March
April
May
June
July
Aug
Sep
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Nov
Dec
Day
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Died from
:
Parkinson's
Other (Please Describe)
:
Service & Burial Info
:
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
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1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Month
Jan
Feb
March
April
May
June
July
Aug
Sep
Oct
Nov
Dec
Day
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Time
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Place
:
Address
:
Memorial Info
:
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Month
Jan
Feb
March
April
May
June
July
Aug
Sep
Oct
Nov
Dec
Day
1
2
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4
5
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Time
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Place
:
Address
:
Please send 10 sheets of personalized stamps with Decedent's Photo
:
Yes
No
Please send 10 sheets of Parkinson's Resource Organization stamps
:
Yes
No
Please select the photo
to be used in the US Postal Stamp
:
(.jpg format only)
Please select photos of
DECEDENT
to be used in the Memorial Wall page
( 5 max, 2MB or less each, .jpg format only)
:
Photo 1 :
Photo 2 :
Photo 3 :
I wish to have a memorial keepsake of a hard covered booklet reflecting
the names, addresses and sentiments submitted by family, friends and relatives
:
Yes
No
I wish PRO to
create
using
PRO Postage Stamp
print
mail
Decedent's Photo Postage Stamp.
(up to 500) Announcements
The Announcement should include
:
Decedent's name as follows
:
Date of birth
Date of death
Date and time of Service & Burial
Date and time of Memorial
Photo No.
of Decedent
This Poem
:
God saw you getting tired When a cure was not to be, So He closed His arms around you and whispered gCome to meh.
You fought a valiant battle and so He gave you rest: God's garden must be beautiful, He only takes the best.
And when we saw you sleeping So Peaceful and free of pain, We could not wish you back to suffer that again.
or
The following poem or words
:
Our mailing list for mailing Memorial Announcements
is attached in the following format
:
MSWord
MSExcel
MSAccess
WordPerfect
Please send
(upto 15) Silver Ribbon Pins
:
Yes
No
Please send
Personalized Tribute Envelopes for distribution
:
Yes
No
Please send notification of this memorial to the following emails :
Separate e-mail addresses by a "," (i.e. Ted@domain.com,Bob@domain.com)
Please copy and paste the Obituary here:
or upload it here
:
(.jpg format only)
We want guests to view and sign the Guest Book
:
Yes
No
Thank you, your memorial will be added after payment confirmation and will appear in
The Parkinson's Resource Organization Memorial Wall
, if you have any question please feel free to
Contact us
anytime.
From all of us at Parkinson's Resource organization please accept our condolences and thank you for helping Parkinson's Resource Organization in a search for a better quality of life for everyone still living with Parkinson's disease.
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