Remembrance Object Contribution Form
Please fill out this form ahead of coming to contribute your Remembrance Object
CONTRIBUTOR INFORMATION
Your Name *
Your answer
Email address *
Your answer
Phone number *
Your answer
What is your relationship to the person being remembered? (note: must be immediate family member) *
Object Return *
If selected yes to the question of object return, please provide mailing address below
Your answer
I will review and sign the participation waiver *
INDIVIDUAL TO BE COMMEMORATED
Responses in this section will be displayed as part of the Chicago exhibition. All questions in this section are required.
Legal name of person to be honored *
Your answer
How would you like this person's name to be displayed? *
This is how your loved one's name will be written alongside the remembrance object. Use the "Other" space to display a name that is different from their legal name.
Required
Please provide a brief description of the remembrance object *
Your answer
Date of birth (of loved one) *
*if using an Android phone, tap "2019" on the top left to update the year
MM
/
DD
/
YYYY
Please provide the city AND state where your loved one was born *
Your answer
Date of death (of loved one) *
*if using an Android phone, tap "2019" on the top left to update the year
MM
/
DD
/
YYYY
Please provide the city AND state where your loved one died *
Your answer
ADDITIONAL INFORMATION
Responses in this section will not be displayed within the Chicago exhibition, but may be used in a digital archive. All questions in this section are optional, and you can leave a section blank if you do not wish to answer it at this time. If you would like to return to answer any of these questions at a later date, please submit the required responses above and start a new form whenever you want to resume.
Caption descriptions
Your answer
EXTENDED DESCRIPTION
You can choose to answer any of the following questions in any preferred way, at any length. If you would like to return to answer any of these questions at a later date, please submit the required responses above and start a new form whenever you want to resume.

Why did you choose this remembrance object?
Do you have any stories you want to share about your loved one?
If you are comfortable, would you describe the circumstances surrounding the loss of the person being commemorated?
Do you think a Gun Violence Memorial is necessary? Why?
Write a response
Your answer
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