The Max Foundation

Memorial Wall Registration

If you prefer to send the information via email, please email your memorial story to thewall@themaxfoundation.org

Or, you can mail the information to:

The Max Foundation
c/o The Wall
110 W. Dayton Str, Suite 205
Edmonds, WA. 98020
USA

Please fill out the form below and then choose Submit

Memorial Name (required)

Date of Birth (required)

Date of Passing (required)

Diagnosis (required)

If "Other Cancer", please specify

If you created a website for your loved one, what is the URL?

A default tribute will be posted in memory of your loved one. If you would like to post your own personal tribute please re-type the text in the box below. Limit of 1500 characters: You are gone, but your memory will live on in our hearts and minds forever. We post this tribute to you to honor your life and the joy you brought to us. We miss you and will treasure your memory always.

Add a picture of your loved one or select one from below. Must be in JPEG or GIF Format

Senders Name (required)

Email Address (required)

Country (required)

Your privacy is important to us. Please read The Max Foundation privacy policy before submitting. When you have finished completing this form, please check your information and then choose Submit.

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Memorial Wall Registration

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