Memorial Serivce Honor Guard Form Note: Any participating Honor Guard personnel must arrive on site, no later than 0900 hrs. Rehearsal starts at 0930 hrs. Please complete the honor guard participation form by filling in all required fields (highlighted in red ), save the PDF and email the completed PDF form to . For additional information and/or questions please email the Command Staff by clicking on the email links provided on the bottom of page 2.Department Name*Department Phone*Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Telephone Number*Honor Guard Commander's InformationName First Last Commander's Rank*Select OneFirefighterFirefighter/MedicLieutenantCaptainDistrict ChiefBattalion ChiefCommander's Email Commander's Cell PhoneCommander's Office PhoneAssistant Commander InformationAsst. Commander's Name First Last Asst. Commander's Rank*Select OneFirefighterFirefighter/MedicLieutenantCaptainDistrict ChiefBattalion ChiefCommander's Email Asst. Commander's Cell PhoneAsst. Commander's Office PhoneParticipant InformationIn order for the Virginia Fire Service Honor Guard Command Staff to efficiently allocate the provisions necessary for the scheduled memorial service, the following information is required. Please complete the following fields, by providing the appropriate information.Honor Guard Participation*Select OneYesNoNumber of Participating Memebers*Select One12345678910Flags*Please do not bring U.S. or Virginia state flags.Please indicate which flags your department will display.City/County FlagF.D. FlagNAIrons*Please note that irons will be used based upon the discretion of the command staff.Select OneAxesPiks PolesNAMusicians AvailableBagpipersBuglersNonePlease indicate if your department has the following internal resources available within your Honor Guard.Please check to indicate you are aware that:*You must read and check you understand each of the conditions below Participants should not bring U.S. or Virginia state flags Irons will be used based upon the discretion of the command staff Representing fire department Honor Guard’s displaying their flags will be mandated to provide their own flag stands Musicians must be proficient and comfortable playing “TAPS” Participation AssignmentsPlease indicate which assignment your department personnel (Honor Guard) would be interested in participating. These assignments are strictly voluntary, but very important to the service and families being honored. All other participation will be unified in the processional of Honor Guard members. Please keep in mind that these assignments are voluntary and the command staff will make final decisions at the time of the service. Your participation is very much appreciated by the families and VFFFMS Committee members.Family Escort NeededEscorts will be assigned to family members and will assist family members with any amenities associated with honoring their loss.Select OneYesNoFamily Escort Participant Name(s)Please provide the name(s) of the individuals wishing to participate as family escorts. Please note that this is your primary assignment, and may very well be your only assignment.Flag of ChoicePlease indicate which flag your department personnel (Honor Guard) would be interested in carrying in the procession.Select OneU.S. FlageVirginia State FlagCity / County / F.D. FlagFlag GuardsA total of eight (8) flag guards are needed for the processional.Select OneYesNoFlag Guard (Name) First Last Tolling of Bell 5-5-5: The Reader will be responsible for the actual reading of the history as it relates to the Tolling of the Bell, while the Toller will be responsible for the actual tolling of the bell. 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Memorial Service Apparatus Form Department NameName First Last PhoneEmail Apparatus Type*Please select one type of apparatusEngine / PumperTruck / LadderTankerBrushSpecialyChief's MedicApparatus Status*Please select status of apparatusIn serviceAntiqueUnits are to arrive between 9:00 AM and 4:00 PM on the Friday before the service for inside staging. Units are to arrive by 9:00 AM on the day of service to be staged inside; by 10:30 AM for outside staging. Use the entrance through Laburnum-Henrico Turnpike Main Entrance. Contact: Mark Buff Email: mark.buff@vdfp.virginia.gov Phone: (804) 249-1965 jQuery(document).bind(‘gform_post_render’, function(event, formId, currentPage){if(formId == 2) {if(!/(android)/i.test(navigator.userAgent)){jQuery(‘#input_2_4’).mask(‘(999) 999-9999’).bind(‘keypress’, function(e){if(e.which == 13){jQuery(this).blur();} } );}} } );jQuery(document).bind(‘gform_post_conditional_logic’, function(event, formId, fields, isInit){} ); jQuery(document).ready(function(){jQuery(document).trigger(‘gform_post_render’, [2, 1]) } );