Inscribe a Name

Now you can preserve the memory of lost friends or loved ones for all time…
Inscribe their names in the Holocaust Memorial Park.

Apply online or download form in Adobe PDF or Word format.

ON-LINE REGISTRATION FORM
Yes, I want to take this opportunity to preserve the names of the victims of the Holocaust for all time! Please inscribe the following name(s) in the Holocaust Memorial Park:
Inscription Information
Name for Inscription
Language to be Engraved	English Hebrew Yiddish Russian
Relationship to you
Birthplace
Please, write briefly what you know about the victim's experience in the Holocaust (e.g. camp or ghetto experience):

You can submit any documents and photos to include in our archive:
My Contact Information
First Name
Last Name
*E-mail Address
Street Address
City
State	Zip
Phone (Day)
Phone (Evening)
Donation to the Holocaust Memorial Committee
Please enclose a deposit for 50% of the total amount for the inscription. Make your tax deductible check payable to the Holocaust Memorial Committee and mail it together with the registration form to: Holocaust Memorial Committee 60 West End Avenue, Brooklyn, NY 11235 After receipt of your registration form and check, we will send you a typed confirmation of the inscription for your approval. Full payment will be due prior to the engraving in the Holocaust Memorial Park.
Donation for Inscription	$360 per line (approximately 26 characters including spaces)
Total: $
The Holocaust Memorial Committee is a not-for-profit organization under section 501(c)3 of the Internal Revenue Code and your donation, for which you received no material goods or services, is fully tax deductible.

Inscription Information