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Submit Details Regarding Dear Person

In order to add your dear person to the internet project In the Memory of Cancer Victims, please submit the form below. Only fields marked with star (*) are mandatory - these are your first name, email address and full name of your dear person. You can find here which measures are taken in order to protect your email address. After you fill the form, click the button below. A new window should open in order to send details by email to fight-cancer@frenkel.ca. You can also attach a picture of your dear person to the email.

After we receive your email:

  1. We will send you confirmation with received details. If you would like to make any changes, please send them to fight-cancer@frenkel.ca.
  2. We will validate submitted details. If there will be any comments, we will contact you by email.
  3. After publishing the submitted details on internet project In the Memory of Cancer Victims, we will send you a notification.

Your first name (will be used for correspondence): *
Email address: *
Full name of your dear person, for example Anna Kur (nee Taub): *
Date of birth: Day: Month: Year:
Place of birth:
Date of death: Day: Month: Year:
Place of death:
Diagnosis:
I confirm that the most close relative of the deceased person
submitted in this form agrees to the publication of submitted
here details on the internet project In the Memory of Cancer Victims 		Agrees
Does not agree
About the person:
Signature for the section "About the person":
If there are words like I or We in the section "About the person", then you should fill this section

After you complete the form above, click this . If for some reason a window for sending the form does not appear, then copy&paste the text below to fight-cancer@frenkel.ca. Do not forget to attach a picture.