Please complete this form to have your loved one
added to Nicholas' memorial page
If the form is not working or if you need to add names
or a picture you can email  me your information
I will email you when your memorial is complete.
If you do not want your email address on the memorial page
note that, but please still put it down so I can 
email you when your memorial is finished.  Also please DO NOT type in ALL CAPS.  

Thank you


Name Of Loved One

Date of Birth

Date of Death

Cause of Death

Age at time of Death(If Miscarriage or Stillborn please use gestational age)

Parent(s) Name(s)

sibling(s)

E-mail address

Site URL

Short quote, verse or poem (Please limit it to no more than 6 lines.)

Please tell me how you found this website? friend? search engine? etc...