1st Annual Sierra Donor Services
Locks of Legacy Memorial Ceremony

Join us for special guest speakers & placement of locks in honor of your loved one.

Thursday, November 12, 2020 at 3 PM

Due to social distancing, this will be a virtual event. An email will be sent with a link to watch the service online.

To reserve a lock, please complete the registration form below.

Locks must be reserved no later than August 28, 2020 to be included in the 2020 memorial ceremony.

Locks of Legacy Order Form

1. Your Contact Information




2. Address 






3. Front of Lock:

Write your message for the front of the lock:
(You will have 3 rows of text, 15 characters per row including spaces)
Example:
front of lock example



4. Back of Lock:
Write your message for the back of the lock:
(You will have 2 rows of text, 15 characters per row including spaces)
Example:
back of lock example






                                   
Media Release
I give permission to DCI Donor Services (DCIDS) to use any and all information I have provided, orally or in writing, including medical information, and any tangible items I have provided, including photographs and videos for the purpose of public and/or professional education about organ and tissue donation. I represent and warrant I am legally authorized to provide such information and items to DCIDS for educational purposes. I understand and agree the information and items I have provided DCIDS, or any part thereof, may be used in any public service medium that DCIDS may choose, including television, radio, website, social media outlets, newspapers, billboards, brochures and pamphlets. I understand upon release of this information, my identity or my loved one’s identity will no longer be confidential since DCIDS has no control over the information once it has been disclosed. I agree and understand I have no ownership and property rights in the information and/or items I have provided to DCIDS. I also understand I will receive no compensation or money for the use of the information and items provided; nor will I be charged anything. I further agree to indemnify and hold harmless DCIDS, its officers, agents and employees from any and all liability arising out of or related to DCIDS’s use of the information and items I have provided.










Thank you! By clicking "Submit" you will be sent to a confirmation page. A staff member will reach out to you directly if we have further questions.
- The Sierra Donor Services Team
916.567.1600


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