The Holocaust Memorial - Submission of Names

To participate in this most worthy effort, please fill out the following information:

The Memorial Wall will stand as a somber reminder of lives lost. Names of Holocaust victims, submitted by their loved ones, will be permanently etched into the wall's black granite, assuring that their martyred names and their memory can go on living forever.

Name:

Address:

City:

State:

Zip:

Submission of Names for the Memorial Wall

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Enclosed is my check* for $

for a total of inscribed names. * $36.00 per name.

Make your tax deductible check payable to the
HOLOCAUST MEMORIAL COMMITTEE
1933-1945 Meridian Avenue, Miami Beach, FL 33139
Phone: 305 538 1663 - Fax: 305 538 2423

Print and send to the address above!