Share Your Memory Submission Form – Nova Scotia Hospice Palliative Care Association

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Select one submission option: **

$25 ( includes one photo of your loved one, their name, life dates and community)

$50 (includes one photo of your loved one, their name, life dates, community, and a 500-word tribute or story)

$100 (includes up to five photos of your loved one, their name, life dates, community, and 1000-word tribute or story)

Name of Person Deceased*

First Name of Person Deceased * Last Name of Person Deceased *

Date of Birth **

MM slash DD slash YYYY

Date of Death **

MM slash DD slash YYYY

Place of Residence of the Deceased **

Upload loved one’s photo. Drag & Drop is NOT an option. **

Max. file size: 4 MB.

Click on one of the images below to select it to appear as a banner behind loved one’s photo:*

Do you need more time to complete your submission? Click on the “Save and Continue Later” link at the bottom of the page anytime. you will be emailed a link that you can use to pick up later where you left off.

Tell us the stories, the experiences, the funny moments you shared.

Tell us how they made a difference in your life or community. Every story is unique. Writing about someone we love can feel daunting. These prompts may be of some assistance. 🍃Describe what brought your loved one joy in life. 🍃Talk about one lesson this person taught you. 🍃Recall why you are most grateful for with this person. 🍃Tell us the funniest moment you shared with this person. If you prefer, another option is to share an existing obituary or eulogy. Proceed with whatever is most comfortable for you.

Tell us the stories, the experiences, the funny moments you shared.

Tell us how they made a difference in your life or community. Every story is unique. Writing about someone we love can feel daunting. These prompts may be of some assistance. 🍃Describe what brought your loved one joy in life. 🍃Talk about one lesson this person taught you. 🍃Recall why you are most grateful for with this person. 🍃Tell us the funniest moment you shared with this person. If you prefer another option is to share an existing obituary or eulogy. Proceed with whatever is most comfortable for you.

Upload up to four additional photos. Drag & Drop is NOT an option.

Max. file size: 4 MB.

I have read and agree with the NSHPCA Virtual Memorial Wall terms and conditions. **

I wish to subscribe to the NSHPCA Newsletter.

Yes

Name*

Your contact details will not be shared and we’ll only contact you if we need clarification of the information you’ve provided for your loved one’s Wall of Memorial.

First Name * Last Name *

Email*

Email * Email Confirmation *

Telephone Number **

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I want to have my name included as the person sharing the memory.

Yes

I want to include a name as the person sharing the memory.

Yes, I wish to include a name

Please specify the name exactly as you wish it to appear

Donations Make all the Difference

Your generosity means we can bring compassion and care to those facing life-limiting illness. Your donation helps build a community of support for those who are saying good-bye to those they love. You will receive a tax receipt for your donation. Today I want to also donate:

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