TheBody.com: An AIDS and HIV Information Resource

	The AIDS Memorial at The Body
	To memorialize someone at The AIDS Memorial, please complete this form. You will then become the registrar for the person's memorial. The password you receive can be used by others who wish to add their thoughts to the memorial. (They'll have to obtain the password from you.) Please keep a record of your password because The Body is unable to supply it if you forget or lose it. Please note: Please make sure that what you or others post is accurate, and that permission is obtained for posting any copyrighted materials.

	Person Memorialized:	Registrar:
	First name:	Your name:
	Middle name:	Your e-mail address (required):
	Last name:	Password:
	Suffix, if desired (Jr., Sr., M.D., Esq., etc):	Re-type password:
	Subheading, to appear below name, if desired:
	State: ^{(i.e. New York, California, or if not from the USA, the nation where the person mainly resided.)}
	Please type your memorial here:

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The AIDS Memorial at The Body