Ultimate Sacrifice Wall Application – Fire Fighters Memorial Foundation of Missouri

Deceased Member Guidelines

The deceased member must have died in an “ACTIVE DUTY” status with a Fire Department in the State of Missouri, which will include: at work at the station, in response to, on an alarm, or returning from and includes, providing service (such as Public Relations). This will cover members of all fire departments, including the Department of Public Safety, where the individual was working as a firefighter. If there are any questions as to an individual meeting the criteria, do not hesitate to ask.

The deceased’s individual does not have to be a member of the Fire Fighters Association of Missouri to be placed on the Memorial Wall.

To find additional information about the Fire Fighters Memorial or the Fire Fighters Memorial Foundation, please do not hesitate to call or contact any Officer or District Representative of the Fire Fighters Association of Missouri.

Application Form

This form is currently experiencing technical issues when using the Chrome browser. Please use Firefox if possible. We apologize for the inconvenience.

Deceased’s Name (First Middle Last) * Next of Kin (First Middle Last) * Street Address * City * State * Zip * Phone * Email *

Department served by the deceased * Rank in department * Department Street Address * Department City * Department State * Department Zip * Department Phone * Chief of Department *

Report of circumstances of death

Deceased’s length of service * Date of death Department name as it will appear on the wall (30 characters max) * Firefighter’s name as it will appear on the wall (30 characters max) * Biography *

The biography should include date of birth, location, last residence, family members—mother, father, siblings, spouse, children and grandparents. Fire department served and length of service, ranks and positions served as well as hobbies, military service, education and any awards or recognition of accomplishments should be included.

After submitting your application, a confirmation page will load. If you don’t see a confirmation, please resubmit your information or contact us. Thank you.