Portage Online - 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 CFRY 920 AM for the selected number of days. It will also be posted on PortageOnline.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 *