Submit a Quilt Square for IIAM's Donor Quilt

Would you like to submit a quilt-square in memory of your loved one for inclusion on IIAM’s donor quilt, “Stitches of Remembrance”? Please fill out the form below. An IIAM representative will be in contact with further instructions.

AUTHORIZATION FOR RELEASE

By completing the form below, I agree to allow IIAM to include a picture of my quilt square on www.iiam.org. I also agree to allow IIAM to reprint all or parts of my story in publications and/or on the internet.

    Your Name*
    Address
    City
    State
    Zip
    Email*
    Phone*
    I'd like to submit a square in memory of*
    His/Her date of birth*
    His/Her date of death*
    He/She was my* (spouse, parent, sibling, child, cousin, friend, etc.)
    Special Instructions* (Please select all that apply)
    Your Story

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