Funeral Announcement Submission Form

Personal Info

Name of deceased *

First

Last

Name Pronunciation

Age *

Address *

Formerly Of

Date of Death

Date of Death *

Location of Death *

Immediate Survivors *

Predeceased by *

Funeral Arrangements (Check all that apply) *

If Other, please describe

Service Date

Service Date / Time

Date

Time

Service Location

Funeral Service Details

Choose One *

Burial
Ash interment
Other
N/A

Burial or Ash Interment Location

Prayer Service *

Prayer Service Date and Time *

Time

Prayer Service Location *

Viewing *

Viewing Date *

Viewing Start Time *

Viewing End Time

Viewing Location *

Viewing Prior to the Service *

Viewing Prior to the Service Location *

Donations can be made to

Donations can be made to a charity of one’s choice

Donations can be made to a charity of one’s choice

Funeral Home in charge of arrangements *

Family Tribute (for online posting only)

Contact Info

Your Name *

First

Last

Your Phone Number *

Your Email *

Email

Confirm Email

Billing

The cost per announcement is $100.00 + GST.

Once your payment has been received, your announcement will be aired on CFAM Radio 950, AM1250 Radio and CJRB Radio 1220 for the selected number of days. It will also be posted on PembinaValleyOnline.com, SteinbachOnline.com, DiscoverWestman.com, and CHVNradio.com.

Payment *

Dates you wish your announcement to air *

Announcement Photo (Optional)

Consent *

I agree to allow Golden West to contact me using this information.

View Privacy details.

Total Amount (including GST)

$0.00

Funeral Announcement Submitter

Funeral Announcement Submitter *

I'm a funeral home submitting this announcement - please send me an invoice.
I'm an individual submitting this announcement - I will submit payment now (required for non-funeral homes).

Name of Funeral Home - for invoice purposes *

Stripe Credit Card *