Request for Inclusion in the Survivor Fund & Wall of The Fallen Application

Click here to download the Information Packet and Application.

  • This Section For Survivor Fund Only

  • *Distribution must be made to someone 18 or older. Any other person than spouse or dependent children must provide proof of dependency on the deceased.
  • Documents Attached

    Documents are not required in order to qualify
  • All pertinent documents should be attached to this form for submission. A copy of the police report should be submitted with this request if available. I certify that the above information is true and correct to the best of my knowledge at the time of submission. I understand that review by ITRHFM is confidential, and that its decision is final. I also understand that any award is discretionary, and that meeting the eligibility criteria does not guarantee an award. Should an award be made to me, I agree in advance to allow ITRHFM to list and publish the donation to me and my family.
  • Verification

  • This field is for validation purposes and should be left unchanged.

Privacy Information: Submitting information is strictly voluntary. By doing so, you are giving the ITRHFM your permission to use the information for the intended purpose. If you do not want to give the ITRHFM Permission to use your information, simply do not provide it. However, not providing certain information may result in the ITRHFM ‘s inability to provide you with the services you desire.
© 2017 International Towing and Recovery Hall of Fame and Museum