The title of your illumination (a short title which we will put on the map) *
Your answer
Your name (which we will put on the map if you want, leave empty if you don't want your name displayed on the map)
Your answer
Your address (please provide your exact address, including postcode, to have the marker placed on the map in the right position; should you not want to be on the map, but still be listed, you may leave this empty)