Memorial Authorization

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 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: June 1, 2026

Contact Person Name

First NameLast Name

Email

example@example.com

I have previously submitted a request and would like for the same materials to be used again:

Are you memorializing a Child or Adult

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

By clicking submit, I hereby give permission for the memorial video to include my name, age, picture(s), and phrases within this form. I also understand that my loved one's memorial will be used until I withdraw my consent.