2025 Submit your loved one's name, dates and photo.

Submit your loved one's name, dates and photo for the Remembrance Dinner hosted by Hope United & Tyler's Redemption Place.

*An event for The Well grief support group
Name of person submitting loved one*

First NameLast Name
Email address*
example@example.com
Phone Number*
Please enter a valid phone number.
Name of loved one lost to addiction or overdose*

First NameLast Name
Relationship to person you are submitting
(son, daughter, mother, father, niece, nephew, friend, etc...)
Birthdate*

MonthDayYear
Date
Date of passing*

MonthDayYear
Date
Photo of loved one lost to addiction or overdose*

Please submit a clear photo of your loved one lost to addiction as a jpg, jpeg, or png file. **(Full body images may need to be cropped before printing.) Thank you!
Cancelof
By submitting this online form, I agree that I have the authority to submit this photo to Hope United | Tyler's Redemption Place and hereby authorize Hope United, Tyler's Redemption Place, and The Well grief support group to use my loved one’s image, name and dates in a Remembrance Service program, remembrance video, and slides. I understand that the Remembrance Service may be streamed on Facebook Live and the Remembrance Video may be shared with Hope United’s social media outlets and supporters.
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Submit your loved one's name, dates and photo for the Remembrance Dinner hosted by Hope United & Tyler's Redemption Place.