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Cemetery, Crematory, and Funeral Home Membership Application

Pennsylvania Cemetery, Cremation & Funeral Association
2200 Northampton Street, Easton, PA 18040
Phone: (610) 253-5222 -- Fax: (610) 253-3636 -- Email: DCM.Colleen@gmail.com

Cemeteries, Funeral Homes and Crematory Membership Application

SECTION A: COMPANY INFORMATION

Company Name:

Address:

Mailing Address (If different from above):

Representative:

Title:

Phone: Fax:

Email:

Products or services you offer:

SECTION B: INFORMATION

Total number of people on payroll: (Full Time), (Part Time)

Total number of years you have been involved in death care services:

Total number of years you have owned, operated or managed this company:

I/ we hereby apply for admission as members of the Pennsylvania Cemetery Cremation and Funeral Association. Membership dues are as published and may change with action approved by the board of directors with due notice to members. If this application is approved, I/we agree to be governed by the bylaws of the organization as they are now or may be hereafter amended. I/We acknowledge that by including our e-mail address, PCCFA is granted the right to send you association information, which may include supplier member’s information, in an electronic form. You will have the right to notify us to opt out of information from supplier members.

I hereby certify that this company is being operated in compliance with all statutory laws and ordinances of our state and local community as they apply to our operations.

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Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

October 13, 2022 11:26 am EDT

Cemetery, Crematory, and Funeral Home Membership Application Uploaded by PCCFA Online - megan.warner@webcemeteries.com IP 73.214.215.96

November 2, 2022 1:20 pm EDT

PCCFA Exec Team - PCCFA.exec.team@gmail.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96

November 2, 2022 1:20 pm EDT

Charles Schwalm - cschwalm@letuminc.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96

November 2, 2022 1:20 pm EDT

Dagny Neel Fitzpatrick - dagny@jeffersonmemorial.biz added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96

November 2, 2022 1:20 pm EDT

Ernie Petersen - southsidestray@mac.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96

November 2, 2022 1:22 pm EDT

PCCFA Exec Team - PCCFA.exec.team@gmail.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96

November 2, 2022 1:22 pm EDT

Charles Schwalm - cschwalm@letuminc.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96

November 2, 2022 1:22 pm EDT

Dagny Neel Fitzpatrick - dagny@jeffersonmemorial.biz added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96

November 2, 2022 1:22 pm EDT

Ernie Petersen - southsidestray@mac.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96

November 2, 2022 1:22 pm EDT

Megan Warner - megan.warner@webcemeteries.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96