Create a Tribute

Add to our Memory Wall

Use this form to share a memory of someone special. You can write a tribute, add an optional photo and choose to make a donation in their memory. Our team will review your submission before it appears on the UHNM Charity Memory Wall.

Create a Tribute

View Memory Wall

In Memory Tribute Form

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Person Being Remembered

Title

Full name *

Relationship (optional)

Preferred display name on Memory Wall *

Your Tribute Message

Maximum 60 characters including spaces. Message will be displayed over two lines.

Your Message *

Who is the message from?

Full name *

Pledged donation amount

Chosen area of support *

Upload your photo

Click or drag a file to this area to upload.

Choose File

Permission has been obtained from everyone shown in the image (if applicable)

I am happy for UHNM Charity to display this tribute for 12 months from the donation date

I confirm that the information provided is accurate and that I have the necessary permissions for any photograph submitted.

Thanks for filling out our form! You will now be directed over to our Zeffy page, where you can leave your pledged donation amount.

There was an error trying to send the form.

Leave a donation in memory

Want to leave a donation in memory? Head directly over to our official Zeffy page to donate.

Donate in Memory

In memory Giving Form

Create a Tribute

Add to our Memory Wall

In Memory Tribute Form

Person Being Remembered

Your Tribute Message

Maximum 60 characters including spaces. Message will be displayed over two lines.

Who is the message from?

Upload your photo

Leave a donation in memory

Let’s stay in touch

Royal Stoke University Hospital

County Hospital

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