Title:

First name:

Surname:

Date of Birth:

Place of Birth:

Town or Village where they lived:

Date of their death:

Date and place of their funeral:

Details of their next of kin:

Employment History:

Interests, hobbies or societies etc:

Name of person submitting details:

Your address:

Your daytime telephone number:




Due to limited space we would ask that you submit a maximum of 450 words together with a photograph which needs to be sent as a jpg attachment, 300 dpi minimum.