Felicity Manor

Please fill-out the widow/widower's contact information below. By registering, we want to emphasize that this information will be shared within Felicity Manor and specific volunteers. All information is kept confidential and is never shared outside of the Felicity Manor organization.

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Email *

If N/A, use best contact email.

First Name

Last Name

Address

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Phone Number

( ) -

Birthday

Month / Day

Spouse's First Name & Month Deceased

WIDOW REGISTRATION