1.  Name of person/pet to being memorialized (20 char max)? 

2.  Name of person submitting the memorial (20 char max)?

3.  Optional (100 char max) Text Message

4.  Your E-mail Address (if we have questions or need to contact you): 

(Please note that we reserve the right to edit the message content.  If you would like to include a photograph of the pet to be memorialzed, please e-mail to ILCockerRescue@aol.com or mail to Illinois Cocker Rescue, PO Box 384, Harvard, IL 60033)