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Memorial Garden Request and Authorization Form
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REQUEST AND AUTHORIZATION
FOR THE INTERMENT OF CREMATED REMAINS

I hereby request permission to hold a memorial ceremony and to bury the cremated remains of __________________________________________ (full name of the “Deceased”) in the William and Mary Memorial Garden.

I certify that I am the person with the full legal right and authority to authorize the disposition of the remains of the Deceased. I understand and acknowledge that once the burial interment is completed, the ashes are not recoverable. I understand and acknowledge that the cremated remains of others may be buried in a similar manner in the Memorial Garden, and that the cremated remains of the Deceased may be inadvertently commingled with those of another person. I understand and acknowledge that the obligation of the William and Mary Alumni Association shall be limited to permitting the disposition of the cremated remains in the Memorial Garden as set forth herein.

I agree to release, hold harmless and indemnify the William and Mary Alumni Association, its affiliates and their agents, employees, successors and assigns from any and all loss, damage, liability or causes of action (including attorney’s fee and expenses of litigation) in connection with the disposition of the cremated remains of the Deceased as authorized herein or respect to the identification of said cremated remains as being those of the Deceased.

______________________________ ______________________________
Signature of Person Authorized Date
To Dispose of Ashes

______________________________
Printed Name of Person Authorized
To Dispose of Ashes

Street Address:___________________________________________________________

City, State, Zip Code:______________________________________________________

Home Telephone/Cell Phone Number:_________________________________________
Email address:____________________________________________________________

ALUMNI ASSOCIATION AUTHORIZATION

I hereby authorize the holding of a memorial ceremony and/or interment of the cremated remains of the Deceased in the William and Mary Memorial Garden

______________________________ ______________________________
Name/Title Date

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