the suicide memorial wall



We invite you to submit the names of friends or family members who died by suicide.  If you include a memorial website address in the comments section, please double check to be sure you have the address exactly right. If the link you send does not take us directly to an individual memorial site, we will not place it on the wall. No commercial sites are allowed.

After we have placed the name you submitted on the wall, you will receive a message notifying you that it is there.  If you do not receive a notification within a week, please resubmit the name.

Love and peace, Karyl, mother of Arlyn (arlynsmom@cs.com)

Items noted by ** are required.
If they are not filled in, the name you submit will not be placed on the wall.


 Required
** First Name to be placed on wall
 

 Required
**Last Name  to be placed on wall

 

 Required
**Age

 Required
** Birth date & Death Dates (Not numerical form)
 

 Required
** Depression? Method of Suicide

 Required
** Location of Suicide: State, Country
  Website Memorial
 
  Would you like an invitation to join our e-mail support group? (Yes or No)
Yes No

 Required
** Your name, first and last.
 

 Required
** Your email address
 

 Required
** Your relationship to this person
 
  How did you find the Suicide Memorial Wall?
 
  Comments

 

 
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Copyright 2004 Sucide Memorial Wall
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