Submit Name for Wall of Remembrance

Anyone can submit a name to the Wall of Remembrance to honor a lost loved one who died during the Killing Fields. Names will be etched on glass panel and preserved for future memory to remember and honor your lost loved ones. We request a minimum $50 donation to offset the cost of etching.

Submissions will be researched and cross-referenced with the Documentation Center of Cambodia (DC-Cam) and other resources.

Names to the Wall of Remembrance are added periodically by glass panel. Please be patient as we will only add names in groupings to complete a new panel.

We are currently accepting names for the Wall of Remembrance

For a limited time only, cost of etching will be waived.

Deadline for Submissions: June 30

Glass Etching Completion: Winter 2020

Questions? Contact memorial@cambodianmuseum.org

Please complete as many fields as possible. Submit a new form for each name to be etched in glass.

Person to Memorialize

Name to be etched on Wall of Remembrance

First Name

Last Name

Date of Birth (if exact date is unknown, please indicate year)

YYYY

Date Deceased (if exact date is unknown, please indicate year)

YYYY

Age at Deceased

Birthplace

Occupation

Person submitting request

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

(###)

###

####

Relationship (How do you know this individual?)

Name Etching

The memorial name will be etched in both Khmer and English. Since there may be several ways of writing the name in Khmer, we prefer that the written Khmer name be provided by you. Otherwise, you can authorize the Museum to write the Khmer name on your behalf.