ShineOn Form

LIGHT A CANDLE

* Indicates required field

Your Name *

First

Last

Your Email *

I choose to have my name anonymous.

I am lighting a candle... *

in memory of a loved one lost to suicide. in honor of a loved one living with bipolar.

My loved one's name is... *

First

Last

Choose Any *

I choose to have my loved one's name anonymous.

Upload Photo (Optional) *

Max file size: 20MB

Submit

If our suicide prevention and mental wellness programs align with your corporation's giving back and employee matching programs, please consider joining forces and becoming a Hope Xchange Corporate Sponsor. Email kerry@hopexchangenonprofit.org to discuss the benefits associated with our sponsorship options and which may be the best fit for your organization.

1-866-55-HOPEX (46739)
INFO@HOPEXCHANGENONPROFIT.ORG

LIGHT A CANDLE

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