Dual Membership | Northern Virginia Burial & Cremation Society

Couple's Registration Fee

$50

(Membership must be issued 72 hours prior to time of death)

Member Information

Please complete all questions below. If you have any questions, please do not hesitate to call us - (703) 760-3077

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Middle Name

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Which of our locations are you closest to?*

Northern Virginia Burial & Cremation Society - Alexandria
811 Cameron Street
Alexandria, VA 22314

Northern Virginia Burial & Cremation Society - Springfield
7516 L Fullerton Road
Springfield, VA 22153

Spouse Vital Information / Second Member Information

First Name*

Middle Name

Last Name*

Country of Citizenship*

Country

Hispanic, Latino or Spanish?*

Race*

Education Level*

Military Service*

Occupation*

*If retired, please list most recent Job Title and Employer

Type of Business/Industry*

Informant Information

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Middle Last

Relationship to Member*

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