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How To Create A Personal Memorial

First of all you will need to register below. Once you have registered, you can start to post your story.

 

Please use the easy drop down menus to provide as much information as you can in the information boxes. The open dialogue boxes allow you to describe what happened after vaccination in your own words (150 words or less).                

 

In addition to the open dialogue boxes, there are several other features which allow you to "personalize" your entry:                

 

• Name: You can use the vaccine victim’s first and last name or you can simply use a first name or nickname for identification purposes.                        
  
  
• Photo: You can post a photo of the vaccine victim from the past or present at the time you submit your written entry. You can also post a photo at a later date.                        
  
  
• Quote: You can select a short quote or write a sentence (up to 10 words) that describes the vaccine victim, which will appear underneath the photo. A line from a favorite poem or a few words which describes something special about the person can be inserted. One mother wrote of her infant son who died after his first DPT shot: "He loved Mozart."                        

Register Please note:The following personal information is for National Vaccine Information Center use only and will not appear on your final webpage.                                 User Name: [Please use your email address to make it easy for you to remember.]    Password: [7 characters or more]    Confirm Password:   E-mail:   Security Question:   Security Answer:   First Name: Last Name: Address: City: State: Zip or Postal Code: Country: Phone:

  

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