To become a member of the Cremation Society of Massachusetts, simply complete this form along with your credit card information. You are a member of the Cremation Society of Massachusetts when this form is received. Within a few days, you will receive your wallet-size membership ID card. Please note that the information on this form is kept strictly confidential.

First Name
Middle Name:
Last Name:
Street Address:
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ZIP Code:	-
E-Mail:
Sex:	Male Female
Marital Status:	Married/Separated Never Married
	Widowed Divorced
Date of Birth:
City of Birth:
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Social Security Number:
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Ancestry:
Race:
Veteran	Yes No
Occupation (Present or Before Retirement):
Employer:
Name of Spouse - First:
Name of Spouse - Last/Maiden Name:
Check if deceased:
Name of Father - First:
Name of Father - Last Name:
State of Fathers Birth:
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Name of Mother - First:
Name of Mother - Maiden Name:
State of Mothers Birth:
Check if deceased:
Next Of Kin:
Relationship:
Address:
Apt/Suite:
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ZIP Code:	-
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Additional Information/Comments: