Funeral Announcement Submission Form

Personal Info

Name Pronunciation

Age(Required)

Address(Required)

Formerly Of

Date of Death(Required)

Location of Death(Required)

Immediate Survivors(Required)

Predeceased by(Required)

If Other, please describe

Service Date

Service Location

Funeral Service Details

Burial or Ash Interment Location

Prayer Service(Required)

Prayer Service Date(Required)

Prayer Service Location(Required)

Viewing(Required)

Viewing Date(Required)

Viewing Location(Required)

Viewing Prior to the Service(Required)

Viewing Prior to the Service Location(Required)

Donations can be made to

Funeral Home in charge of arrangements(Required)

Family Tribute (for online posting only)

Contact Info

Your Phone Number(Required)

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(Required)

Dates you wish your announcement to air(Required)

Announcement Photo (Optional)

Max. file size: 64 MB.

Total Amount (including GST)

Funeral Announcement Submitter

Name of Funeral Home - for invoice purposes(Required)

Credit Card