Pink and Blue Landmark Capture Form

Building/Landmark Name (required)

Building/Landmark Address/Location (required)

Name of Person Contacted/Responding (required)

Email Address of Person Contacted/ Responding (required)

Let us know the results of your request (required)
Yes we are able to support BLAWNo we are unable to support BLAW at this timeWe may be able to support BLAW next year

When will the Building/Landmark be illuminated? (required)
Entire BLAW 9-15 OctoberFor 15 OctoberFrom 7pm on 15 October Wave of LightWe are unable to illuminate the building

Additional Information (required)

Submitting your contact details indicates that you’re happy to hear from Baby Loss Awareness Week, managed by the charity Sands. By agreeing to be contacted by Baby Loss Awareness Week, you are agreeing to have your data safely stored and protected by Sands. We will not pass your details to any third party organisations. You can update your preferences or opt out at any time: simply click an unsubscribe link in the email you receive from us or call 020 3908 5525 or email babyloss@sands.org.uk