NMRM_brick_submission

Create Your FREE Memorial Here

It takes quite a bit of information to both generate a Brick Memorial and an Online Memorial for a fallen rider. Please be patient and try to provide all the information. If you don't know a piece of information, then please indicate that you don't know. Or, answer None. If you don't readily have all the information that you need available, please click on the link just below this and print out the form, gather that information and then return here to submit your memorial. The printable form is below. Click the link to load it. Thank you and don't hesitate to contact the NMRM for more help if you need to.

Information gathering form

Name of fallen Rider:

Full Name - First and Last

**Fallen Rider's Nickname or Road Name (if any)

If Rider has none, please type in "None".

Fallen Rider's Date of Birth dd/mm/yy

Day/Month/Year - example, 01/01/01

Fallen Rider's Date of Death dd/mm/yy

Day/Month/Year - example, 01/01/20

Fallen Rider's Place of Residence at time of death- City

City

Rider's State

State

Veteran?

Yes No

Branch of Service or 1st Responder duty

1st Responder?

Yes No

Was this person's death the result of a motorcycle accident?

Yes No

Affiliations (Club, Charities, Riding Groups, etc.) or type in "None".

**Epitaph (no more than 21 characters/spaces per line

No more than 21 characters, including spaces.

** No more than 21 characters, including spaces

** No more than 21 characters, including spaces. Leave blank if you attach clipart.

**Please note that each 8x8 brick only has space for 3 lines of text. If you choose to include a clip art design (motorcycle, wings, angel, etc.), then only 2 lines of text are available. Each line should be a phrase that is no longer than 21 characters including spaces.

Select a clipart file on your computer

File can only be up to 1 MB in size.

Person Submitting - First Last Name

Please provide your name so our representative can contact you if there are questions.

Relationship to deceased

NMRM Member?

Yes No

Submitter's Address

We need your address to send you the plaques that commemorate your brick.

City

State

Zip Code

Phone Number (format) 111-555-1212

Please provide your phone number in the format indicated, so our brick rep can call with any questions.

Cell or Alt Phone (format) 111-222-2121

Please follow the format as indicated.

Your Email (please follow the format in the text box)

Please fill in your email address. We will never give or sell your email address to any 3rd party company. We don't do that

We are almost there!! Only a couple more things to do. We have an online memorial that we plan to have a kiosk at the memorial site. Each brick has a page or more of pictures and an obituary for each fallen rider who have a brick. Please gather the information according to the form above and then continue below.

Select a single photo file or a zip file

Gather photos to submit. You can upload photos for the online Memorial as a single file if you select them all in a Windows folder and right click and send to a compressed folder. That will create a .zip file that you can attach to the form. That is how you send multiple picture files. The maximum file size allowed is 8MB.

Select a single Obituary text file that you created on your computer.

Write an Obituary for the fallen Rider for the Online Memorial. The file size limitation is 1MB

Don't forget to click on the Create it Now!! button below!!