Submission Form
International Overdose Awareness Day
2023 Outdoor Commemorative
Photo Displays
in Montgomery County
August 31, 2023 - September 30, 2023
Please submit commemorative photo banner requests as soon as possible, but no later than August 15, 2023. All submissions will be printed & installed as the display is evolving, but please note printing & installation of late submissions may be delayed past the opening dates.
I give permission to show the picture of my loved one in the Montgomery County public display.
If your loved one was included in the displays in previous years, they will be included again in this year's display unless we hear otherwise from you. You do not need to resubmit the information or photograph, but please update contact information if needed.
Please enter your information (which will remain private) below:
Your Name
Your Mailing Address
Please enter your loved one's information below:
Loved one's first and last name (Only the first name and first initial of the last name will be displayed on the photo banner)
Loved one's date of birth (Not displayed on the photo banner)
Date of death (Not displayed on the photo banner)
Attach 1 photo for the commemorative banner of your loved one. A high resolution photograph is PREFERRED. Please attach an original photo (not cropped) in jpeg, tif, or png format.