The Office of The Bronx Borough President: Bronx Virtual COVID Memorial
To submit information about a Bronxite who was lost to COVID-19 on the website of The Office of The Bronx Borough President, please fill out the form below. Once we've received your submission, we will send you an email to ask if you'd like to include a photo to include when posting your submission.
* Required
Name of person to memorialize
*
Your answer
Your name
*
Your answer
Your relationship to person to be memorialized
*
Your answer
Your email address
*
Your answer
Your phone number
Your answer
Please share a brief explanation of why this person was special to you
*
Your answer
I hereby state that all information I have submitted on this form is valid and truthful and grant permission to the Office of The Bronx Borough President to use the name, likeness and memorial words written on its website.
*
I accept*
Required
Please type your initials
*
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
