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Information Request

Please fill out the following information so that we can contact you.

Name:
Street Address:
(line 2):
City:
State:
Zip:
Email Address:
Please indicate notifications you would like to receive:	I would like to be notified when a prayer vigil is taking place. Please put my name on your mailing list. Please include my loved one on the unsolved homicide list.
Name of loved one:
Date of death:
Age at time of death:
Relationship to loved one:
I would like to make a donation to P.E.A.C.E.:	Yes No
Request: