Memorial Garden Brick Application

Name(Required)
MM slash DD slash YYYY
Address(Required)

About your loved-one taken by violent crime

Brick Engravement Details

Limited to 22 characters including spaces
Limited to 22 characters including spaces
Limited to 22 characters including spaces
This field is for validation purposes and should be left unchanged.

If you have any questions, please contact Dianna, NCVAN Memorial Garden Coordinator, at 919-831-2857 x 106 or dianna@nc-van.org.