Ontario Professional Fire Fighters Association
Ontario Professional Fire Fighters Association
 

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Ontario Fallen Fire Fighters Memorial Submission
First Name of Deceased *
Last Name of Deceased *
Municipality *
Rank *
Age *
Date of Death *
Cause of Death *
WSIB Number *
WSIB Confirmation Letter *
Claim Accepted *
KIN INFORMATION
Next of Kin First Name *
Next of Kin Last Name *
Next of Kin Address *
Address 2
City *
Province *
Postal Code *
Next of Kin Phone Number *
Children of Deceased (if known) *
YOUR INFORMATION
Your Organization's Name *
Your Fire Chief's First Name *
Your Fire Chief's Last Name *
Your First Name *
Your Last Name *
Your Title *
Your Address *
Address 2
City *
Province *
Postal Code *
Your Phone Number *
Your Email Address *
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