In Memory Form | Richmond Hospital Foundation

纪念筹款网上申请表

感谢您通过为自己所爱之人建立纪念筹款网页，以支持列治文医院基金会。请您提供以下所需资料。我们将为您建立纪念筹款网页，并在上线前通过电子邮件向您发送链结，供您查看。

In Memory Form (sc)

Thank you for your interest in supporting Richmond Hospital Foundation by creating a memorial page for your loved one. Please provide the information required below. We will create your tribute page for you and email you a link to review before it goes live. (sc)

Name of the person you are remembering: (sc)

Name (sc)(Required)

First (sc) Last (sc)

Memorial Page Content (sc)(Required)

Please add the content you would like to appear on the memorial page. Many people will share a favourite memory or story about their loved one, or will include information from the obituary. (sc)

Please direct any gifts received towards (sc)(Required)

(if you would like your funds designated to an area not listed, choose “other” from the dropdown and type in the name below) (sc)

Other (sc)

Photo Upload (sc)

Accepted file types: jpg, jpeg, png, gif.

Please include a photo of your loved one that can be displayed on the memorial page. Preferred image size is 300px x 300px. (sc)

Contact Information (sc)

Please let us know who we should contact in regards to this memorial page. (sc)

Name (sc)(Required)

First (sc) Last (sc)

Address (sc)(Required)

City (sc)(Required)

Province (sc)(Required)

Postal (sc)(Required)

Phone (sc)(Required)

Email (sc)(Required)