Snowflake Request Form
Mahalo for your interest in Light Up a Memory 2025. Press the next button to request snowflakes. If you do not want to request a snowflake, you can close this window. If you are unable to fill out this form right now, you can access it through your confirmation email or through our website: stfrancishawaii.org/luam For assistance, email us at luam@stfrancishawaii.org.
Full Name
*
First Name
Last Name
Phone Number
E-mail
*
example@example.com
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Snowflake Request Form
You may submit this form as many times as you wish to request snowflakes.
Snowflake Option 1 (Text Only)
Snowflake Text Line 1 (16 character limit)
Snowflake Text Line 2 (16 character limit)
Snowflake Text Line 3 (16 character limit)
If you would like multiple copies of this snowflake, how many would you like printed?
Snowflake Option 2 (Text and Image)
Attach Your Photos
If you would like to include your loved one's picture on your snowflake, please upload a bmp, gif, jpg, jpeg, png, tif, or qtf image. Enter your personalization for the person(s) or pet(s) to be remembered. Each snowflake can have a photo and 1 line of text with 16 characters (including spaces). If you are having trouble uploading your photo, please email your photo to lightupamemory@stfrancishawaii.org. Please be sure to include your full name in the body of the email so that we can match the photo to your request. You can submit this form as many times as you'd like to request additional snowflakes.
File Upload
Browse Files
Drag and drop files here
Choose a file
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Snowflake Text (16 character limit)
If you would like multiple copies of this snowflake, how many would you like printed?
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Event Video Disclaimer
If you are submitting your request prior to Monday, November 17, you have the option for your loved one's name(s) to be showcased in the event video. Please read the following event video disclaimer and if you would like for your loved one's name(s) to be included, please sign below. I understand St. Francis Healthcare System intends to use the name and any photos of my loved one that I submit in a respectful manner for the Light Up a Memory video. This event video is designed to honor loved ones of families and to be viewed by the public, and will be posted on the St. Francis Healthcare System website and used for possible future marketing purposes. St. Francis Healthcare System will not be responsible for how this event video may be used by the general public. I may provide written notice to St. Francis Healthcare System to revoke this authorization at any time. Upon notification, St. Francis Healthcare System will remove the name and photos for my loved one from the event video. I further understand this authorization is not connected in any way to admission, treatment, or payment for any services provided by St. Francis Healthcare System. I am an authorized representative of my loved and agree to the terms above.
Name of Loved One
Your Name (This will serve as your digital signature)
Today's Date
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Month
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Day
Year
Date
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