(877) 798-5431
Eating Disorders Anorexia Bulimia Compulsive Overeating at Something Fishy Website
Learn About:
Eating Disorders
Anorexia
Bulimia
Overeating
Binge Eating
something-fishy sitemap  


privacy policy
legal stuff
site updates
sitemap
CONTACT

     Memorial Wall :: Submit A Name
Request Memorial...

Lighting A Candle for a Loved-One

4/18/07: This form is currently unavailable due to the heavy abuse by automated spam bot submissions. Return soon or email info (at) sfweb . com.

Is is incredibly painful to lose someone you love and we do not wish to make the process any more difficult. The form below seems cold and impersonal and it is not intended that way... for the benefit of everyone we just need to ensure accuracy.

We DO NOT accept submissions from those who are still alive but feel as though they may be dying, nor do we accept submissions regarding any person who is still alive. No matter how ill someone may be, there is always hope.

Please don't submit fraudulent information. Requests are manually reviewed and approved or rejected.

If information is incomplete, inaccurate, or not signed at the bottom, your request will not be added to something-fishy.org.

INFORMATION TO APPEAR "IN LOVING MEMORY"
PLEASE INCLUDE THE INFORMATION EXACTLY AS YOU WOULD LIKE IT TO APPEAR "IN LOVING MEMORY" -- BE SURE TO PROOF READ YOUR SUBMISSION BEFORE HITTING THE SUBMIT BUTTON.
In Loving Memory of: (Full Name of Deceased)
What you would like to say In Loving Memory of your loved-one:
REQUIRED INFORMATION
PLEASE INCLUDE THIS INFORMATION IF YOU HAVE IT
SELECT WHETHER YOU WANT IT TO APPEAR OR REMAIN CONFIDENTIAL.
Date of Birth: MM/DD/YYYY date format
Yes, this should appear with my loved-one's name
No, this should NOT appear with my loved-one's name
Date of Death: MM/DD/YYYY date format
Yes, this should appear with my loved-one's name
No, this should NOT appear with my loved-one's name
CONFIDENTIAL INFORMATION
YOUR NAME AND E-MAIL ADDRESS ARE REQUIRED
FULL NAME OF THE DECEASED, LOCATION OF DEATH AND SOCIAL SECURITY NUMBER INFORMATION IS FOR OUR VERIFICATION PURPOSES ONLY AND IS KEPT STRICTLY CONFIDENTIAL.
INFORMATION BELOW WILL NOT APPEAR on "IN LOVING MEMORY"
Your Name:
E-mail:
Your relationship to the Deceased:
Location where the person passed away: City
State or Province
Country
Deceased Social Security Number: Strictly Confidential - Verification Purposes Only
AGREE and SIGN -- REQUIRED
Send It! BY DIGITALLY SIGNING THIS FORM and CLICKING ON I AGREE, IN ACCORDANCE WITH ALL APPLICABLE STATE AND FEDERAL LAWS, YOU AGREE THAT THE INFORMATION SUBMITTED IN THIS FORM IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE AND NOT INTENTIONALLY FALSIFIED IN ANY WAY.

DIGITAL SIGNATURE (Your Full Name):


:: Memorial Wall :: Request Memorial ::

back to top Back Home
Copyright ©1998-2014 The Something Fishy Website on Eating Disorders: All rights reserved.
Terms & Conditions, Privacy Policy