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Create a Bell of Hope Memorial Fund or a Suicide Prevention Memorial Fund

Honor your loved one by creating a Memorial Fund or a Suicide Prevention Memorial fund to place in the Bell of Hope Memorial. (Complete the form below or print out the printer friendly form.)

 

*Your Name:

*E-mail Address:

*Phone Number:

Street Address:

City, State:

Zip Code:

*Name of Deceased:

*Deceased Date of Birth:

*Deceased Date of Death:

*Your relationship to the Deceased:

   

I wish to set up a:
(select one):

Memorial Fund

Suicide Prevention Memorial Fund
 

Yes, I wish to designate

% of the gifts contributed to this Fund be shared with the Mental Health America Affiliated Mental Health Association of my choice.

 

Please send notifications of contributions to this fund to (if someone other than yourself):

Name:

Street Address:

City, State:

Zip Code:

Their relationship to the deceased:

   

Please create an online memorial:
(select one):

Yes

No
   

Comments:

If you have a picture of the deceased you would like us to post on the memorial please send it via US Mail or email to the gift office (contact information below)

*Required fields

Please be sure to provide your contact information so that we may contact you with any questions.

For more information, contact the Mental Health America Gift Office:

giftoffice@mentalhealthamerica.net
Mental Health America
Attn: Gift Office
P.O. Box 16810
Alexandria, Virginia 22302-0810
703-838-7542