EmailMe Form - I Am Project

Name of resident

First Middle Last

Nickname

Birthday

MM / DD / YYYY

Hometown
city, state

Hobbies

Career(s)

Favorite foods

Favorite treats, food or non-food

Favorite music/songs

Favorite book(s)

Favorite movies/TV

Favorite vacation spots

Words of wisdom or favorite advice

Favorite childhood memory

Fun fact

Close friends

Religious affiliation

Family members

Contact person (name)

First Last

This person is someone who knows the resident and can answer basic questions about the resident, if needed.

Contact person (phone)

### - ### - ####

Please upload 2, 3, or 4 photos of your loved one.

File Upload

The final section requests information about the survey respondent, or the person completing the survey.

Name of person completing the survey

First Last

Your Email Address *

Your telephone number

IMPORTANT NOTES:

1. If you are collaborating with others to complete the form, you may share the link to the form so everyone can respond to the questions, but PLEASE ONLY SUBMIT ONE FORM.

2. Due to the volume of requests we receive, it has been determined for expediency to limit the number of reviews to one.

3. Your poster will be designed within 5 business days of receipt. The product will be emailed to you for one review. You will have 5 business days to accept or reject the suggested edits. If you do not reply to the suggested edits, it will be assumed that you accept the edits, & the poster will go to print.

Questions? Please submit through the provided text box.

PAYMENT

Price includes professionally designed 16x20 poster print, black wooden frame, & professional grade hook, & shipping or local delivery. *

Please choose one poster print from the dropdown menu.

MAILING ADDRESS *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region