Book of remembrance order form - Cardiff Bereavement Services

Your details

Name

Email

Address

Postcode

Telephone (for contact during working hours)

Would you like your entry to appear in the red or blue book of remembrance?
RedBlue

On what date would you like the entry to appear?

Details of text

Line 1 is for the forename(s) and surname only and must not exceed 25 letters and spaces. The remaining lines may contain a maximum of 30 letters and spaces.

If you are commissioning a design of artwork, floral emblem, badge or gold or coloured capital letter, the cost includes a five-line entry.

25
30
30
30
30
30
30
30
30

Please select one option to be included in your entry:

Gold capital letter with scroll workGold capital letter with roses entwined around itColoured capital letter with roses entwined around itFloral emblemBadge or coat of armsOther art design

Please select the colourRedBlue
Please specify type and colour of flower

Please specify or provide photo/badge for copying

e.g. Religious symbols, animals, logos etc – please include an example for the artist to copy

Remembrance card

If you wish to order a Remembrance card, containing an inscribed copy of the entry you have composed for the Book of Remembrance, please state the number of cards required

If you have chosen a gold or coloured capital letter or have commissioned a work of art do you wish to include this in the card?

YesNo

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