It could be your own message or you can feel free to use one of the examples listed below. Check the box below that applies to you. If you are adding your own message, there is a message box to enter it below the example comments. Please try to keep personal messages to a minimum of 3 to 4 lines. If I receive longer messages, I may have to ask you to edit it so that it can fit on the space available for each name.
Recovery is worth fighting for.
Before your name will get added to the Survivor's Wall, I will contact you to confirm the information you want displayed. Please fill out name and email address below so that I can contact you. If I cannot contact you to confirm, your name will not be added to the Wall. Email addresses are kept confidential. If you do not receive a confirmation letter from me within 2 or 3 weeks of submitting, please resubmit your message.