Your loved one’s story can change lives.

Thank you for taking this step. We know this is not an easy moment, and we’re here to walk alongside you. This form gives us the details we need to set up your personalized fundraising page. Our team will be in touch within 4 business days.

Your memorial fund will:

Honor your loved one’s memory
Inspire safe driving or support young innovators
Give friends and family a meaningful way to contribute

Your Information

First Name

Last Name

Email

Phone

(###)

###

####

About Your Loved One

Full Name of Loved One

Short Tribute (2–3 sentences)

Example: “In loving memory of Jordan Taylor, whose laughter lit up every room. This fund will carry forward his passion for helping others and keeping roads safe.”

Your Fund’s Purpose

Select the impact you’d like this fund to have:

Fund a one-time grant ior scholarship n their name ($5,000)

Fund 5 years of grants or schoarshop in their name ($25,000)

Create a permanent annual grant or scholarship in their name ($100,000)

Fund a Safe Driving Week ($3,500)

Other (please specify)

Optional Details

Preferred Start Date

Special Requests

Speak to a Memorial Fund Specialist
703-448-0436

After Submission

Once you submit this form:

We’ll review your information and create a private draft of your fundraising page.
You’ll receive a preview link to approve the photo, tribute text, and goal.
Once approved, your page will go live, and you’ll receive a starter kit with:

A direct link to your page
Social media post templates
Email text you can send to friends and family
A printable flyer (optional)

We’ll be with you every step of the way, and you’ll receive updates as your fund grows and begins making a difference.

Speak to a Memorial Fund Specialist
703-448-0436

Your loved one’s story can change lives.

Thank you!

After Submission