CCA Website Request & Information Form
Your name
*
First Name
Last Name
Your email
*
example@example.com
Your phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which website design would you like?
*
Stillwater
Passage
Kindred
Heirloom
Gathering
Service area
*
Towns and communities you serve
Do you return calls the same day?
*
Yes
No
How quickly do you usually reply?
Your photo
*
Upload a File
Cancel
of
Short bio
*
Years of experience or number of ceremonies led
Your credentials
*
The kinds of ceremonies you lead
*
Religious
Non-religious
A blend of both
Ceremonies you offer
*
Funeral services
Memorial gatherings
Celebrations of life
Graveside services
Where you lead ceremonies
*
Funeral homes
Places of worship
Graveside
Family homes
Outdoors and other meaningful places
Typical ceremony length
Do you have testimonials we can include on your website?
*
Yes
No
Testimonial 1
Testimonial 1: first name
For example: Susan, her father's funeral
Testimonial 2
Testimonial 2: first name
Testimonial 3
Testimonial 3: first name
Testimonial 4
Testimonial 4: first name
Permission to publish
I have each family's permission to publish these words on my website.
Your website address will be
firstnamelastnamecelebrant.com
, for example
wayneprevettcelebrant.com
.
Or is there a domain name you would rather use?
*
Yes
No
Preferred Domain name
Please confirm
*
I confirm the information I have given is accurate and may be published on my website.
Anything else we should know?
Payment Details
Celebrant Website Yearly Subscription
*
prev
next
( X )
Celebrant Website (Annual Subscription)
(
$125.00 CAD
$
125.00
CAD
for each
year
)
Annual Fee
Credit Card Information
Name
First Name
Last Name
Do you wish to use a company name in the header of your webpage?
No
Yes
Company Name to use in the header of your webpage?
Your E-mail
Should be a specific email for your clients. Ex. name@gmail.com
Phone number for clents to contact
Region Served (Do not enter Ontario as your region!)
Do not enter Ontario as your region.
Website Choice
Black
Blue
Black/Red
Blue/White
Green
Ceremony Fee
Other CLM training you have taken
Wedding Officiant
New Life
None
In addition to providing a funeral, memorial and graveside service, please check all that apply to you below.:
Officiating a Service of Remembrance
Meeting the terminally ill to help them plan their memorial service
Meeting with families in person to help plan the memorial service
Assist in writing a eulogy
Assist in choosing appropriate music for the memorial service
Directing families and individuals to grief support networks
Guest speaker
Keynote speaker for seminars
Seminar presenter on the topic of planning a memorial service
Inspirational speaker
None of the above
Other
Facebook Business Page URL**
**Facebook URL can be added later.
Submit
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