THE LYING IN STATE OF HER MAJESTY QUEEN ELIZABETH, THE QUEEN MOTHER

Lords are asked to return this form to Black Rod's Office by Thursday 4 April

Name and Decorations:

[Block Capitals please].........................................................................................................................

1.   Arrival of Cortège

I intend/do not intend* to be present at the arrival of the Cortège at Westminster Hall on Friday 5 April

I will/will not* be accompanied by my spouse.

2.  Lying in State: Unescorted guests

I require one/two* tickets for unescorted guests on the following dates:

a)	Saturday 6 April	(i)	(Print his/her name).............................
		(ii)	(Print his/her name)............................
b)	Sunday 7 April	(i)	(Print his/her name).............................
		(ii)	(Print his/her name).............................
c)	Monday 8 April	(i)	(Print his/her name).............................
		(ii)	(Print his/her name).............................

3.  Departure of Cortège

I intend/do not intend* to be present at the departure of the Cortège from Westminster Hall on Tuesday 9 April.

I will/will not* be accompanied by my spouse (see Paragraph 1)

Signature of Lord.................................................................

*Please delete as appropriate.