Your Name

Your Email

Name of the individual we are memorializing

Are you an immediate family member to the individual?
If not, please have a family member submit this form.
—Please choose an option—YesNo

What is your relation to the individual?
—Please choose an option—ParentSiblingOther member

If "Other member", please specify:

Date of Birth

Date of Passing

Upload your file or image (10mb limit)

Please confirm the correct name, date of birth, and date of passing before hitting submit.
Changes cannot be made after.
—Please choose an option—I confirm all information is accurate.

Do you agree to the Memorial Submission Terms of Agreement:
By submitting a memorial request, you agree to the following terms and conditions:
1. In-Person Pick-Up Requirement: You agree to pick up your memorial plaque in person at the end of the race. Memorials will not be shipped under any circumstances.
2. Photo Submission Option: If you are unable to pick up your memorial plaque, you may opt to submit a photo instead, therefore opting out of the memorial plaque. The photo, of your chosen size, should be sent to: 2729 E. Lehigh Ave, Philadelphia, PA 19125.
Please note that submitted photos will also not be shipped. There will be a dedicated space to hang these photos during the event.
3. Submitter Responsibility: Memorial plaques will be given exclusively to the person listed as the submitter. Ensure that the information provided is accurate and up-to-date.
4. No Shipping Policy: Memorial plaques and submitted photos will not be shipped. All collections and submissions must be handled as per the guidelines stated above.
5. Alternative Plaque Orders: If you wish to obtain a plaque separately, a link will be provided upon request for you to place an order independently.
By agreeing to these terms, you acknowledge your understanding and acceptance of the conditions set forth for memorial submission and collection.
I consent to the Memorial Submission Terms of Agreement.