Memorial book

Little Hearts Matter will be creating a special memorial book which will be displayed here on our website later this year. If you would like to have someone’s name and a small message included in this special book, please complete the form below.

Full Name*
First Last
Are you a full member of Little Hearts Matter?*
- Yes
Email Address*
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Phone*
The name of the person you would like us to add to the Memorial Book*
First Last
Their Date of Birth*
Date Format: MM slash DD slash YYYY
The date that they died*
Date Format: MM slash DD slash YYYY
Please write a line of text that you would like to appear with their name in the Memorial Book*
Contact consent
We would like to be able to contact you regarding this and other future LHM events. Please tick how you would like to be contacted.*
- Post
- Email
- Phone