Make New Memories

Our Make New Memories program is open to all victims of mass violence. You can apply for yourself or nominate a survivor or the immediate family member(s) of a victim of mass violence. To apply, please fill out the form below.

 
We will respond to you within one week of receiving your application. 

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Full Name *
Email *
Mailing Address (Street, City, State, and Zip Code) *
Phone Number *
Are you applying for yourself or someone else? *
If you are applying for someone else, what is their FULL NAME? 
What is the NAME and/or LOCATION of the mass violence incident? For example, Pulse Nightclub (Orlando, FL), Robb Elementary School (Uvalde, TX), etc.  *
Briefly Describe Your New Memory Request.
 *
Is travel required? *
How many people will participate? *
What is the ideal date for this new memory to happen?

For example, December 20, 2029.
*
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