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Houston North Emmaus Community


  
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HNEC Memorial Page Request
Please fill in the below form to provide information on a deceased Emmaus pilgrim to be included on the HNEC Memorial page. Please submit all information that is known, including the Submitter Information section at the bottom (scroll down if necessary) in case we need to contact you with additional questions.
Deceased information:
Name:*
Community & Walk #:*
Church affiliation:*
Date of Death:
(write out as in January 1, 2020):*
Information Submitter:
Name:*
Email:*
Phone:*
Have you received permission from an immediate family member of the deceased to have this information posted on the HNEC web site?*
 Yes
 No
Next of Kin of Deceased Information
Name:
Relationship
Phone:


Submit
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