"SAY MY NAME" CANDELIGHT VIGIL
REGISTRATION FORM

Please complete this form by November 20, 2023

I give the Care U Community Health Center and other cooperating organizations permission to use my name and any photograph, voice or likeness of me or my during the event in any promotional materials or publications. I consent to and authorize in advance such use and waive my rights of privacy in connection therewith.

During our "Say My Name" Candlelight Vigil and on our "Wall of Rememberance" display, we will be reading names and displaying photos to remember those who have passed away due to HIV/AIDS. If you would like to honor an immediate family member or public figure, please provide their name and/or picture below. If you are honoring someone who is not an immediate family member or a public figure, please complete the written permission form and upload the document below.

CARE 4 U

COMMUNITY HEALTH CENTER

"SAY MY NAME" CANDELIGHT VIGIL
REGISTRATION FORM

Please complete this form by November 20, 2023

Please complete the Written Permission Form and upload.

RELEASE FORM

Use your mouse or finger (on touch screens)

CARE 4 U

COMMUNITY HEALTH CENTER

​CARE 4 U

COMMUNITY HEALTH CENTER

"SAY MY NAME" CANDELIGHT VIGIL REGISTRATION FORM

Please complete this form by November 20, 2023

Please complete the Written Permission Form and upload.

RELEASE FORM

Use your mouse or finger (on touch screens)

​CARE 4 U

COMMUNITY HEALTH CENTER

CARE 4 U

"SAY MY NAME" CANDELIGHT VIGIL
REGISTRATION FORM

CARE 4 U