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In remembrance of those whose child or a family member has passed away due to complications of congenital melanocytic naevus, we would like to take a few moments and remember these people during the 2024 conference.

The memorial will be a video and candle lighting for each person. Additionally, the memorial will be shared on social media as a lasting tribute following the conference.

*** Deadline to request remembrance: May 30, 2024

Contact Person Name*

First NameLast Name

Email*

example@example.com

I submitted a request in 2022 and would like for the same materials to be used again:*

YesNo

Are you memorializing a Child or Adult*

ChildAdult

Name of Child *

Age of Child when passed*

Name of Adult *

Personal message or phrase for the video (not mandatory):

Add attachments of picture(s) of child or family member.

Memorial Gathering*

I would like to have a candle lit and name said during the conference to remember my child or family member.I DO NOT wish to have a candle lit and name said during the conference to remember my child or family member.

By clicking submit I hereby give permission that the memorial video will include name, age, picture(s), and phrases within this form.