Memorial Page Authorization Form

Thank you for trusting Not One More Alabama to memorialize your loved one by adding their photo to our webpage: https://NotOneMoreAlabama.org/memorials.

PLEASE NOTE: THIS FORM IS FOR THE WEBSITE PUBLICATION ONLY.

This form and release provides us with important information required for our records.

Not One More Alabama can only accept memorial requests from immediate family members (parents, children, siblings, spouses, grandparents or legal guardians). Other circumstances are considered on a case-by-case basis. So please contact us with any questions: 256-384-5055.

Please complete this form so that we may reach out to you if we have any questions. You can always email us directly with your questions: memorials@notonemorealabama.org

Email

example@example.com

Name of person submitting a request

First NameLast Name

Please check below your relationship to the individual who will be memorialized.

Are you 19 years old or older?

Phone number of the person submitting this request

Please enter a valid phone number.Format: (000) 000-0000.

Address of the person submitting this request

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of person memorialized

First NameLast Name

Please complete the options you prefer below. Only complete the information that you are giving NOMA permission to publish.

Use my loved one's FIRST NAME and LAST INITIAL listed below

Use my loved one's FULL NAME listed below

You may use my loved one's AGE at DEATH

You may use my loved one's DATE of BIRTH

You may use my loved one's DATE of DEATH

You may use my loved one's HOMETOWN listed below

I hereby permit and authorize Not One More Alabama, Inc. (hereinafter “Not One More Alabama”), and its agents and representatives who are acting on behalf of Not One More Alabama to use the likeness of my loved one along with information provided in this document for purposes related to its mission without any compensation to me. I understand and agree that these materials will become the property of Not One More Alabama and will not be returned.

I hereby irrevocably authorize Not One More Alabama to edit, alter, copy, exhibit, publish, or broadcast my loved one’s likeness at any time by means of any media, including print, website placements, or memorial events. In addition, I waive any right of privacy associated with my loved one’s likeness as well as the right to inspect or approve the finished product, including written or electronic copy, wherein my loved one’s likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my loved one’s likeness.

I hereby hold harmless and release and forever discharge Not One More Alabama, Inc., its officers, directors and volunteers from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

This authorization and release is granted on a continuing basis and will remain in effect year after year unless and until I provide written notice or revocation. To withdraw permission, I will notify Not One More Alabama in writing via email or mailed correspondence, at which point reasonable efforts will be made to discontinue future use of the image.

Email:
memorials@notonemorealabama.org

Mail:

Not One More Alabama, Inc.
Attention: Memorials
P.O. Box 161 Huntsville, AL 35804

I have read this release (as stated above) before typing my name below and I fully understand the contents, meaning, and impact of this release. I acknowledge that signing or typing my name in the space below will serve as my authorization.

You may type your name in the space below

You can upload a photo of your loved one here. For privacy reasons, we ask that you include only your loved one being memorialized in the photo. Some circumstances allow us to crop another individual out of the photo. If this is the case, please attach more than one photo for use to choose for the website.

Photo files should be print quality - a minimum of 250KB.

You may also deliver a photo to our office at:

2200 Bob Wallace Ave. SW
Huntsville, AL 35805

Or mail a photo (photos will not be returned)

Not One More Alabama
Attn: Memorial Page
P.O. Box 161
Huntsville, AL 35804

Please reach out to us with any questions or concerns: 256-384-5055 or email memorials@notonemorealabama.org

File Upload

Please provide the date you are completing this form

Date

Memorial Page Authorization Form

Authorization for Use of Image or Likeness and Collection of Data for Memorials