Wall of Hope Tribute

Thank you for sharing your loved one's story to be featured on our Wall of Hope. Please complete this form with the information you would like us to include in the tribute.

Our team will contact you if we have questions.

Wall of Hope Submission 3

Your Name

Your Email

Your Phone Number

If we need to contact you for more information about your tribute, what is the best way to reach you?

Call

Text

Your Loved One's Name

Your Relationship to Donor

Your Loved One's Date of Birth

Please provide 3-5 words to describe your loved one

Share 3-4 sentences about a favorite memory with your loved one

Tell us about your loved one in a little more detail

Share 2-3 sentences about what your loved one liked to do in their free time

Would you also like to include your tribute in our Hero Highlight social media series? (example pictured)

Yes

Please upload 2-3 photos for our team to choose from (We will pick the picture that fits our graphic the best)

Select Photo

When you click the SEND button, you will be taken to a new page to review and sign the LifeShare Carolinas Authorization to Use and Disclose Health Information for Communications and Marketing form. By signing this form, you are giving LifeShare permission to share details of your loved one's organ, eye, or tissue donation.