Please submit your Memorial Tribute information here. All of this information is secure and will be verified prior to placement on the ACEMS Council Web site. All fields must be completed in order for submission to be completed correctly. Incomplete forms will NOT be placed on the web site. If you wish, you may e-mail a digital photo of the individual for which you are paying tribute. Send 1 photo only please and e-mail to: garyharvat@comcast.net. If you have questions please feel free to contact Gary Harvat at 412.858.2089
Your Name: *
Your Contact Phone for Verification Purposes: *
Full Name of Deceased: *
Date of Death: *
Age at Time of Death: *
Tribute (Please Keep to 150 words or less): *
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Submissions will take approximately 3-5 business days before placement on the site.