Add a Tribute

If your life has been touched by donation, we invite you to post a tribute honoring the donor and the Gift of Sight she or he made possible. You may submit a tribute using the form below, or send your tribute to us via fax or mail.

Contact Information

Your contact information is not required. You can submit your tribute anonymously. However, providing contact information allows us to follow up with you if we have questions or problems with submission. It also allows us to notify you when the tribute has been added to our site. The Eye-Bank does not sell, share or release your contact information to other organizations. Privacy Statement


1.	Your Name
	I want my name to appear as the author of the tribute. Yes No


2.	The Donor was my
	I want my relationship to the donor to appear on the tribute page. Yes No


3.	Your E-mail Address
	I want my E-mail address to display on the tribute page. Yes No


4.	Your Daytime Phone #	- -

Tribute Listing

The information you provide here will be used to list the tribute on the "View Tributes" page of the Web site.

5a. If submitted under the Donor's Name, the tribute will be listed alphabetically by last name, first name (e.g., under "S" for "Smith, John").

5b. If you want the donor to remain anonymous, or if you simply don't know the donor's name, you may have your tribute listed by a title instead. In this case, leave the Donor's Name blank and enter a Title for Anonymous Listing.


	Please complete one only.
5a.	Donor's Name (First, MI, Last)
	OR
5b.	Title for Anonymous Listing

Your Tribute

Enter your headline and tribute here or skip these fields and attach a document below.


6a.	Headline (optional)


6b.	Enter any text for your tribute here (lines will wrap automatically).


6c.	Attach a document (optional)
	(see Document Guidelines)

Photograph(s)

(optional)

You can submit up to three photos or images to be included with your tribute.
Please review our Photo Guidelines before submitting images.


7a.	Attach Photo #1
7b.	Attach Photo #2
7c.	Attach Photo #3
	Please check here if you are sending us photos or other materials via US mail. Eye-Bank Mailing Address


8.	Please add my name to the Eye-Bank mailing list. (optional) Privacy

	Name (First, MI, Last)
	Street Address
	City
	State
	Province
	Zip / Postal Code
	Country


9.	Special instructions or comments:

Please click the Submit button only once. Depending on the size of your attachments and the speed of your Internet connection, the submission may take several minutes. Please be patient. An acknowledgement page will appear when your submission has been transmitted.