World AIDS Day Wall of Remembrance Name Submission Form
Share the names of your loved ones and people who you’d like to remember who died of HIV/AIDS. After submitting the form you will have the option to submit additional names.

All submissions will be added to our Wall of Remembrance as they are received, within one business day of submission.

View the webpage :
Sign in to Google to save your progress. Learn more
Name (as you wish it to appear) *
I would also like their name added to the "Night Sweats" virtual program book
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of New Haven Pride Center. Report Abuse