Please Print Out This Form, Fill It Out, and Mail It Along With Your Check To The Address Below.

Lifekeeper Memory Quilts

If someone close to you has died by suicide: a child, parent, sibling, relative or friend and you would like to have them remembered on the Maryland State Memory Quilt,  contact:

SPEAK (Suicide Prevention Education Awareness for Kids) at
P.O. Box 36802
Towson, MD 21212
410- 377-7711

                             OR

Email speakforthem@aol.com

                             OR

 email mmclofspeak@hotmail.com

The cost for a Quilt piece packet is $50.00.  Make check payable to SPEAK, Inc. 

Please note on the check that it is for the quilt packet.

Name:_________________________________________________

Address:_______________________________________________

Phone Number:__________________________________________

e-mail:_________________________________________________