Please complete and send this form in order to request a User Account (username and password) that will allow you to access the members-only areas of Selected's website. Headquarters also will use the information you provide to update your listing in the membership database.
Your request must be manually processed to confirm your affiliation with Selected Independent Funeral Homes, so there may be some delay before you receive you Log In information. If you have any questions about the status of your request, please contact Headquarters at 1-800-323-4219 or firstname.lastname@example.org.
(*) denotes required information. Thank you.