Fentanyl Victims Network of North Carolina
JOIN Fentanyl Victims Network of North Carolina (FENTVIC - fentvic.org) to build a grassroots network in all 100 NC counties.

After submission, please provide a photo of your loved one to memory wall on the web site.  The email address to send your photo to will be provided in the submission confirmation.  Photos should be:
  • High quality resolution
  • Free from words and decorative overlays or borders
All victim photos displayed are the property of bereaved families and Fentanyl Victims Network of North Carolina. Any copying, reproduction or independent redistribution without prior permission for use is strictly prohibited.

Your contact information will not be used for solicitation purposes.  It will only be used for news and events related to this organization.

Please allow one week for FENTVIC to verify your data and publish on the web site.

Note:  You will NOT receive a confirmation email upon submission.  The email address to send your photo to will be displayed on the submission confirmation page.


First Name *
Last Name 1 *
Last Name 2
City of Residence *
County of Residence *
Phone *
Email Address *
Relationship to Victim *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy