2024 Deceased Member Form

Deceased Member Form 2024

Please complete and submit for members who died July 1, 2023 - June 30, 2024 Forms must be received by August 15th to be included in this year's memorial service.

• Please complete and submit for members who passed away JULY 1, 2023 – JUNE 30, 2024

  This list must be submitted by AUGUST 15th of each year to be included in the VSFA Convention’s Memorial Services. Names received after that date will be included the following year. PLEASE INCLUDE A PICTURE AND COMPLETE ALL INFORMATION BELOW FOR PROPER RECOGNITION.

• Department Name*
• Address
  Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Secretary Name*
  First Last
• Phone*
• Email*
• DECEASED MEMBERS JULY 1, 2023 – JUNE 30, 2024*

  Name	DOB	Date of Death	Years of Vol. Service

  Click the + symbol to add additional lines.
• Additional Info
  Life Member, Offices Held, etc.
• Upload Photos
  Drop files here or Select files

  Accepted file types: jpg, jpeg, png, pdf, tif, tiff, Max. file size: 2 MB.

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