Membership Form - Direct Cremation of the Seacoast

What Does Our Free Membership Do?
It saves you and your family from the inflation of cremation costs. Unlike some cremation providers, we do not require a membership fee or payment in advance to lock in today’s price. Just complete the simple membership application below and receive your free membership card and lock in today’s price of $1250 for tomorrows need.
Member/Preneed’s Name*
First Last
Member/Preneed’s Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Member/Preneed’s Email*
Member/Preneed’s Phone*
Next of Kin*
First Last
Relationship to Member/Preneed’s*
Next of Kin Address*
Same as Member/Preneed’s Address

Street Address City State / Province / Region ZIP / Postal Code Country
Next of Kin Email*
Next of Kin Phone*
Contact Regarding Membership*
- Member
- Next of Kin
Preferred Method of Contact*
- Email
- Phone
How did you hear about us?*
- Internet
- Referral/Friend
- Advertisement
- Other
How did you hear about us (Other)*
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.