In Honor & In Memory
Create a lasting impact for your loved one. Honor someone who has passed or celebrate an accomplishment. Make a donation to Take Back The Night Foundation to sustain our ongoing work to support survivors, raise awareness, and end sexual violence. This form is for those who can contribute $500 or more, to be listed on our "In Honor & In Memory" page. We appreciate all who want to support our Foundation, regardless of the amount. For donations under $500, please use the DONATE button at takebackthenight.org. Donations are tax deductible. Please note in completing this form, you understand and agree that TBTNF may use your submission and data as part of its aggregate reporting, operations, and internal review. TBTNF does not sell your personal data or contact information to any 3rd parties.
Your Name
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First Name
Last Name
Your Email Address
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Confirmation Email
Your Cell Phone (US Country Code = +1; Canada Country Code = +1; Australia Country Code = +61; UK Country Code = +44; find other Country Codes at https://countrycode.org/)
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Country Code
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Area Code
Phone Number
Best Method of Contact?
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Email
Phone
Do you want to receive the TBTNF Newsletter (free) and be invited to our Global Events?
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Yes
No
Are you honoring a loved one who has passed or an accomplishment?
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In Memoriam (loved one who has passed)
In Honor (accomplishment)
Legal Name of Honored
Name of Honored as You'd Like Listed
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Five short lines (3-4 words max each) of personal descriptions and/or titles (see https://takebackthenight.org/give-in-honor-or-in-memory for example)
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Date of Accomplishment
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Title of Accomplishment
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Please upload the image you would like featured. Options:
A photo of the honored person
A photo representing something about them (an animal, a hobby, a flower, beach, etc.)
A candlelight vigil image without identifiable people (sample image – may select from https://campusoutreachservices.egnyte.com/fl/SURdW5AHyz)
Please upload the image you would like featured. Options:
A photo of the honored person
A photo representing the accomplishment
Upload image to be featured on website.
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Would you like us to create a social media post about your loved one?
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Yes
No
What would you like the blurb to be for the social media post (125 character max)?
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Enter any Facebook Accounts you would like tagged:
Enter any Instagram Accounts you would like tagged:
Enter any LinkedIn Accounts you would like tagged:
Enter any Twitter Accounts you would like tagged:
Please verify that you are human
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Your Donation Amount: Donations of $500+ qualify for listing on the In Honor & In Memory page on our website. Levels: Candlelight-$500-$749 | Shine Bright- $750-$999 | Ignite the Night - $1000+
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