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Funeral Notification Form
If you know of an AMFA Local 4 member who has lost a family member (Mother, Father, Spouse, Committed Partner, Child or Step Child) please complete the following form so we may honor them with flowers or a charitable donation. Although we would like to honor everyone who is important in our members lives we have to limits gifts to only family members who would be eligible for travel benefits. Please provide as much information as you can.
Your Name:
Your Phone #:
Members Name:
Members Loss:

Mother Father Spouse Child

Step Child Committed Partner

Funeral Date:

Funeral Information:

*Please provide as much

information as possible*

6102 S. Archer Ave. #102
Chicago, IL 60638

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