Identify Your Environmental Aims The ranking of these environmental benefits can be used to ensure your final arrangements are reflective of the environmental considerations most important to you. Environmental benefits that mean the most to me in order of importance are: (#1 most important, #4 least important) # Conservation of natural resources # Reduction of carbon emissions # Protection of worker health # Preservation/restoration of habitat
Identify Your Economic Aims # Forgo viewing # Eliminate the vault # Opportunity to put a second body in the grave # Simple casket or shroud
Identify Your Spiritual Aims # Family members at graveside to view # Participation of family/friends, encouraging ritual # Creating an authentic religious experience # Making a spiritual connection with nature, acknowledging the life cycle
Designate a Funeral Service Provider My preference is to have my funeral coordinated by:
A funeral establishment belonging to the Green Burial Council’s network of approved providers prepared to conduct my green burial* Contact information:
A family member/friend whom I have chosen to handle my arrangements** Contact information:
Other (Explain relationship; if applicable, indicate location of your Designated Agent documentation) Contact information:
*If you have prearrangements with a funeral home that is not a part of the Green Burial Council list of approved providers, discuss your intentions with your funeral director to determine if they can meet your needs. The Green Burial Council is happy to assist the funeral home in understanding the procedures for facilitating a green burial.
** Please check to ensure that your state allows for a funeral to be facilitated without a licensed funeral director. As of 2012 the list of states that require families to use a licensed funeral director are as follows: CT, IA, IL, IN, LA, MI, NE, NJ, and NY.
How I Want My Body Prepared I approve of the following practices/products to temporarily preserve my body after my death: Dry Ice Techni-ice or ice packs Refrigeration Topical application (i.e. sprays, compounds) using nontoxic, essential oils Topical application and/or internal injection (excluding arterial injection) using nontoxic, essential oils Topical application and/or internal injection (including arterial injection) using nontoxic, essential oils
Choosing My Burial Container My preference is for one of the following GBC approved: Casket Shroud Urn
I wish to have my burial container obtained from: Other (Explain)
Designing My Funeral Service My preference is for a: Private open casket funeral Private closed casket funeral Public open casket funeral Public closed casket funeral Public closed casket funeral with a private viewing of my body prior to the funeral Public closed casket funeral with a private viewing of my body after the funeral Other (Explain)
My preference is to have: A graveside funeral only A funeral at my home A funeral at the funeral home handling my arrangements (identified above) A funeral at the following specified location: Other (Explain)
Where I Wish to Be Buried I have made arrangements for burial at Contact information I have not made arrangements for burial at a cemetery I would like to be buried on my property (at the location identified on the map attached to this document) and have verified with my local planning/zoning board that burial is allowed to take place on this property Other (Explain) My contingency plan in case there are no green burial grounds in or near my community is to have my body transported to: A GBC approved burial ground within 1000 miles of my home A GBC approved burial ground within 500 miles of my home A GBC approved burial ground within 100 miles of my home Other (Explain)
Marking My Grave I would like to have:* A tree as a marker No marker on top of my grave A rock as a marker My name listed on a central/memorial marker Wildflowers or native plants planted on top of my grave instead of a marker A rock as a marker engraved with the following words: Other (Explain)
*Please be advised that these choices will not be available at all cemeteries. Please contact individual cemeteries to determine which options are available.
If I Choose Cremation I would like to: Choose a cremation technology that leaves a lower carbon footprint Choose a cremation facility that recycles medical parts Offset the carbon emissions from cremation by making a donation in the amount of $_________ to the following carbon fund Choose to have my cremains go into a biodegradable urn Have my ashes given to I request that they be committed in the following manner Other (Explain)
Signature Date Printed Name
Recommendations This document was created to assist in the planning and facilitation of your green burial. It addresses the components of a green funeral/burial, and serves as a supplement to any other end-of-life planner you may be using. A full list of Green Burial Council approved funeral establishments, cemeteries, and product manufacturers can be found at: http://www.greenburialcouncil.org/finding-a-provider/
The GBC suggests that you email and/or give hard copies of this completed Planning Guide to a family member/friend, your next-of-kin, attorney, estate planner and the funeral home and/or cemetery with whom you have made your final arrangements, along with any other specific instructions you have made regarding your funeral/burial. If you need further help or have any questions, please email the Green Burial Council at email@example.com or call 888-966-3330.
For detailed information about what constitutes a green burial, see the Green Burial Council publication Going Out Green:Four Ways to Ensure an Eco-Friendly Burial, available for download on the website www.greenburialcouncil.org