Submit a Name | The Suicide Memorial Wall

Important: The email address provided must be valid so that we can notify you after the name is on the site. If the email address is not valid, the name will not be placed on the wall.

You will receive an email from one of the POS-FFOS volunteers after the name has been placed on the wall.

Note: You may be asked to provide an obituary or other evidence that the death was by suicide.

1 · About the Person Being Remembered

First Name *

Last Name *

Location (City is optional — State / Country is preferred)

Birth Date

Death Date

2 · About You

Your Full Name *

Your Relationship to the Deceased

Complete the sentence: "I am this person's ___"

Your Email Address * (Must be valid — we'll email you once the name is on the wall)

3 · Additional Information

Yes, I would like information about one of the email support groups: Parents of Suicides (POS) or Friends and Families of Suicides (FFOS). (There is no charge.)

Comments for the Site Volunteers (not displayed on the website)

1 · About the Person Being Remembered

2 · About You

3 · Additional Information

Submission Received