Individual Membership | Northern Virginia Burial & Cremation Society

Individual Membership Fee

$30

(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

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*

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

Spousal & Parental Information

Marital Status

Name of Spouse

First Last

Spouse's Maiden Name

Father's Full Name*

First Last Suffix

Mother's Full Name*

First Last Suffix

Mother's Maiden Name*

Informant Information

Name*

Middle Last

Relationship to Member*

Address*

Street Address City State ZIP Code

Phone*

Email*

How did you hear about us?

Checkout

Total (Including 3% Processing Fee)*

Price: $0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Name

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