Ceremony Request Form To request a Living Tribute click here Name of Deceased: Do we have permission to use the deceased's name in the ceremony? YesNo Would you like an electronic copy of the "Nightingale Tribute" for your loved one? YesNo Deceased's Representatives Information Name of Representative Email: Phone Number: Location Information Name of Funeral Home: Address: Date of Ceremony: Time: Who should be presented with the Lamp/Rose?: Ceremony Specific Information Preference for rose placement? On the casketIn the casketNear casket/urn (specify where) Would you like to speak to us prior to the ceremony? YesNo Representative's Signature Date: NHGSTL Representative Signature Date:
