Online Tribute Submission Form All tributes in this section have been added at the request of a victim/survivor or a member of their family. We do need to have the permission of the injured victim/survivor or the next of kin of the victim/survivor before posting the tribute. This can be emailed or scanned and sent to mwetmore@madd.ca. If you have any questions on your submission, please contact Meghann Wetmore at 1-800-665-6233 ext 225 for assistance. Please allow a few working days for your submission to be approved and posted. If you prefer to print a form and submit by mail, please click here. * indicates required fieldYour InformationYour name *First and last name of person submitting tributeI am a *Victim/survivorParentSiblingSpouse/partnerFamily relativeOtherIf other, please specify Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryTelephone number *Email address *Tribute InformationName of victim/survivor *Third party proof *Third party proof in victim's/survivor's crash is required. Accepted file formats: JPG, PDF, DOCX, DOCDate of crash You can use pop-up calendar or type date in window. Date format: mm/dd/yyyyAge at time of crash Home city and province Your tribute *Text of your personalized online tribute (250 words or less)Tribute photo Please upload a photo of the victim/survivor. File must be in JPG format.Additional photos (Please combine into a .zip file) If you are adding more than one photo to the tribute, please combine them in a .zip file and upload here. Limit: 20 photos; size limit: 25MB.Customized tribute image Please choose an image for the top of the tribute page.CandlesWinter sceneTeddy bearsWater sceneField of daisiesCanoesBird in cloudsSports equipmentDragonfliesGuest memories section *Do you want other people to add memories to this tribute page? All submissions are subject to approval by MADD Canada staff.YesNoOther information Is there anything else you would like us to know? MADD Canada reserves the right to edit statements to conform to spacing constraints. By submitting information for the inclusion in the Online Tribute, you acknowledge that the information may be reproduced, altered or rebroadcast by parties who visit the site. You agree that MADD Canada is not responsible for any errors, alteration or damage to information provided by the victims' family, or for the use of any such information or material by anyone accessing or linking to the tribute website. MADD Canada maintains the right to exclude any photograph and/or tribute which does not comply with current MADD Canada policies. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
