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Membership Application

Your lifetime membership includes you, your spouse or domestic partner, and your dependent minor children. Please print this application and enclose a check or money order payable to FCAGR.

NOTE: This application is not for filling out online. Please CLICK HERE to print and mail your request to us.

Mail to:
Funeral Consumers Alliance of Greater Rochester
220 Winton Road South
Rochester, New York 14610 

 

Amount enclosed:
$35   $50   $100    Other____________

Name__________________________________________________________

Spouse/Partner__________________________________________________

Telephone______________________________________________________

Address________________________________________________________

City, State, Zip +4________________________________________________

Email__________________________________________________________

I would like additional information about:
Cremation How to pay for a funeral
Green burial Body donation to medical science
Should you prepay? Organ & tissue donation
How to choose a funeral home Other________________________________________

I want to volunteer to assist with:

The Newsletter   Clerical work   Speaking

Other _____________________________________________________

I learned about the Alliance from _________________________________

Please send ____ additional brochures for me to distribute.