District Nine Memorials 
Former and current Altrusans who passed away May to present will be honored at the next District Nine Conference.

District Nine Clubs may honor deceased members with a special memorial recognition by submitting the information below.  

Questions? Contact us at DistrictNineAltrusa@gmail.com
Sign in to Google to save your progress. Learn more
Club Name *
Full Name of Deceased Member *
Birth Date: *
Death Date: *
Member of Altrusa since (Year): *
Altrusa Highlight: *
Please provide ONE short paragraph highlighting this member to be shared as part of the memorial service. For purposes of time, this submission may be edited.
PHOTO: Please submit a Photo of the Deceased Member (a high resolution JPEG format is preferred) *
Required
Your Name *
Your Email *
Your Phone Number *
Member Obituary Link
If there is an obituary weblink, please provide it here.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report