Classical Jazz '05
A Way to Remember

During our Program of Remembrance and Celebration, we are going to take a few moments to honor our loved ones who died by suicide by having their names read. This very moving way of remembering them has become a traditional part of the ceremonies for many of the Out of the Darkness Community Walks being held across the country.

If you are planning to come to this great event, you may also choose to participate in this tribute. You can have the name of your loved one mentioned with you as their survivor. For example, someone might have read:

Mary Smith
or
Mary (etc)
is being remembered today by
Janice Smith
(and / or)
her Mother
(and / or)
her family
(and / or)
her friends
(and / or)
her classmates (etc)

You would fill in these blanks just the way you want them read.

Please know as names are spoken, there will be appropriate music in the background. They will be read with the greatest of respect. And, of course, this would only be done with your written permission. If you would like to be included in this part of the ceremony, pleased fill out the form below.

We must receive this information absolutely no later than September 8, 2009

I would like to participate in the September 12, 2009, Out of the Darkness Community Walk's Program of Remembrance, Celebration and Hope by having my loved one and myself included in the reading of names as follows: Please be sure to fill this out exactly how you'd like it read. The absolute deadline to receive this information is September 8, 2009. If you have any concern that the names may not be pronounced correctly, please be sure to include that below under "special pronunciation instructions," or call Chris Gilchrist at (757) 483-5111.

Name of loved one lost to Suicide:
is being remembered today by
Survivor/s present at Walk:
Name of Survivor/s or your Relationship:
Your Name:
Your street address:
Your city, state & zip:
Your phone number:
If there are any special pronunciation instructions,
please add them:
By checking the “yes”, I give permission to the Out of the Darkness Community Walk, its committee, and volunteers to read the above during the ceremony:
Date of permission:
If you would like an e-mail confirmation, please give your e-mail here:
 

Please Note: This form will be activated in March 2009