2024 - 2025 Care Team Request Form

Your first name

Your last name

Your email address

Care and Concern

Member's Name

Member's JLD member number

Please tell us whether this is for illness, surgery, illness in the family, or a difficult season of life.

Birth Announcement

Mother's Name

Father's Name

Baby's Name

Baby's Birth Date

Baby's Photo

Wedding Announcement

Bride's Full Name

Spouse's Full Name

Wedding Date

Wedding Photo

Professional or Civic Accomplishment

Member's Name

Accomplishment Title

Accomplishment Description

Attach Photo

Condolences

Member Name

Name of Deceased

Relationship to Member

Was the deceased a JLD Member? Select ... Yes No

Attach Photo

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