Memorial Registry Form

Online Memorial Registry Enrollment Form

Thank you for your interest in enrolling a loved one in our Online Memorial Registry. Those enrolled will be remembered in our Monthly Novena of Masses and Daily Rosary. Additionally, those who are deceased are remembered in the daily Masses throughout the entire month of November.

The Online Memorial Registry suggested donation is $50. Once you submit your Online Memorial Registry form you will be redirected to our secure donation page. We will be in touch if we have any questions about your submission.

Once entered into the Online Memorial Registry, all photographs and records are part of the public domain. Each Online Memorial Registry includes one photo and a brief memorial statement. Please note: The Basilica of the National Shrine of the Immaculate Conception reserves the right to screen and edit individual records to ensure that content and material are appropriate for public use.

If you have any questions, please call the National Shrine at 202-526-8300. Thank you.

Thank you for your support of the National Shrine!

View sample certificate

Your Personal Information (all required fields)
Your Name*
First Last
The name of the person filling out the form.
Your address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Email*
Please provide the following information about your Online Memorial Registry.
The following onformation will be displayed on the Online Memorial Registry and will be viewable online and can also be printed out for personal use.
Person to be enrolled
First Last
The name of person to be enrolled.
Enrolled by

The name of the person, persons, or group making the enrollment.
Significant dates

What is the significant date for the enrollment.
Memorial message
Please enter your memorial message with no more than 400 characters.
Upload photo*
Accepted file types: jpg, gif, png, Max. file size: 500 MB.
Upload the photo you would like to be included (the image you upload must be no more than 500kb resolution and in one of the following formats: jpg, gif, png).
*If you do not upload a photo, we will use a Basilica image.

Online Memorial Registry Enrollment Form

Online Memorial Registry Enrollment Form

Your Personal Information (all required fields)

Please provide the following information about your Online Memorial Registry.