Step 2: Request Memorial Page

Now that you’ve selected where you want honorary donations to go, please fill out the rest of the information below. In four weeks, you will receive a list of all the people who donated in your loved one’s name. A Donor Ministry representative will contact you soon to finalize the information and get your memorial page up and running.

Your Contact Information
TITLE*
NAME*
ADDRESS*
CITY*
STATE*
POSTAL CODE*
How do you prefer Samaritan's Purse to contact you?*
Phone*
Email*
Enter Email Confirm Email
Memorial Information

Please use the section below to let us know about the person being memorialized.
NAME*
CITY*
STATE*
MEMORIAL SERVICE DATE*
MM slash DD slash YYYY
YOUR RELATIONSHIP TO THE PERSON BEING MEMORIALIZED*
OBITUARY*
gift designation
gift description
If you would like, please attach a photo of the person being memorialized. (This is not required.)
Images should be no larger than 5MB, and may be in one of the following formats: JPG, GIF, PNG, TIF, or BMP. iPad users must be using iOS version higher than 6.

Add file... Your file has not been uploaded.
Gift Designation

Gifts donated from the memorial page will be designated to:
Comments

Please use the section below to let us know any special instructions regarding the memorial page.
MESSAGE TO OUR STAFF
CAPTCHA
Hidden - photo file path
Comments
This field is for validation purposes and should be left unchanged.

Step 2: Request Memorial Page

Your Contact Information

Memorial Information

Gift Designation

Comments

More

You are visiting the international website for Samaritan’s Purse, headquartered in the United States.

You also may be interested in visiting and giving through our affiliate sites: