Bereavement Notification

Shiloh Baptist Church family expresses our condolences during this time of bereavement. It is our goal to assist
you in recovery from this experience while placing you on the path of healing.

Remember, we are here to share scriptures, and pray for you and your family.

Take a moment to complete the form below, and let us help you in your time of need.


* Required Fields 
*Contact Name:First	  Last 
*Address: 
Street Address:		
Address Line 2:		
*City:			
State 			  Postal/Zip Code 
 
Contact Phone Number	
* Email			
Are you a member of Shiloh Baptist Church?	YesNo
Name of Deceased: 
Title   
First: Last: Suffix: 
Is this person an immediate family member?	YesNo
If yes, your relationship to the individual? 
				FatherMotherSiblingSonDaughter
When did the individual pass away?
Are you considering Shiloh Baptist Church for homegoing services? 
				YesNo
If yes, what is the proposed date of the service?
*Verify 
	
 

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