Intracoastal Cremation Society

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I n t r a c o a s t a l C r e m a t i o n S o c i e t y

MEMBERSHIP APPLICATION

Please complete the following application and submit. Upon completion, you will be redirected back to our enrollment page to continue with the necessary paperwork process. As always, if you have any questions, please call us at (910) 473-2273.

Full Name:	First, Middle, Last
E-Mail:
Telephone Number:
Address:
City:
State:
Zip:
County:
	Please check if residence is in city limits.
Date of Birth:
Place of Birth:	City, State, County
Sex:
Race:
Social Security Number:
Education:	Years of School/College
Occupation:
Industry or Business Type:
Father's Name:
Mother's Name:	Please include maiden name
Marital Status:
Spouse's Name (if applicable):	Please include maiden name
	Check here if you are a Veteran. (If so, please mail a copy of your discharge papers)
Closest Informant (if no spouse):
Relationship:
Address:
Telephone Number:
Upon submission of this information, your application for membership into Intracoastal Cremation Society will be received by our office. You will be directed back to our enrollment page where you can begin completing the necessary paperwork as indicated by item #2 in our list. Although we may receive this electronic membership, your membership is not effective until payment has been received. Our enrollment page will explain payment options to you, as you can pay via check or online with MasterCard or Visa. Fees are $30 for an individual and $50 for a couple. If a couple is joining, please submit a second online application with their information as well. As always, if you have any questions and/or concerns, you may reach us at (910) 473-2273. BY SUBMITTING THIS ONLINE MEMBERSHIP APPLICATION, YOU ARE CONFIRMING THE INFORMATION PROVIDED IS CORRECT AND ACCURATE TO YOUR ABILITY AND YOU ARE AGREEING THIS TRANSMISSION ELECTRONICALLY WILL OFFICIALLY SERVE AS YOUR SIGNED APPLICATION.