Memorial

   
Complete this memorial form. Click on Submit when ready to send.

ASH is gathering names of tobacco sufferers - people who have died from smoking tobacco products. Online victims is a global list and includes celebrities, like former Beatle George Harrison, who died at only 58 from a tobacco caused disease. 

In Australia, smoking kills over 19,000 people a year, more than half in middle age. This includes 7,200 deaths from cardiovascular disease and 6,600 from cancer. In one year alone, it has been estimated that smoking caused the loss of 88,266 person years of life (1992).

This list is a memorial for the people who have died and for those they have left behind. If you would like to add the name of a family member, a friend or a loved one please complete some or all of the details below. 

Your name:

Email address:

Victim's name
Disease
Date of Death
Age at Death
Residence
Occupation



Family members and comments






For example, enter details under the headings as follows:


Victim's name		Ross Jones, aged 61
Disease			Heart disease
Date of Death		1978
Age at Death		61 years
Residence		Taree, NSW
Occupation		Council worker and WW2 veteran
Family Members		Mother Ella, brother Robert and nieces.

Then click the "Submit" button, if you make a mistake click the "Reset" button to clear the details and start again.
These details will be considered by ASH and may be posted on the Memorial List. If ASH decides to post the memorial, a representative of ASH will contact you.