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LINE OF DUTY DEATH
Last Alarm: June 25, 2018

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THIS SITE IS NOT FOR THE GENERAL PUBLIC
Memorial is open to the public - do not register
<<PUBLIC PARKING INFORMATION>>

FIRE PERSONNEL – DIGNITARY – VIP REGISTRATION

If you would like to register Apparatus – Pipe & Drum Corps – Honor Guards or Law Enforcement Vehicles please use THIS FORM >>>

Registration for Captain David Rosa's Celebration of Life

NOT FOR THE GENERAL PUBLIC
Long Beach Fire Chief Mike DuRee is requesting that all agencies and dignitaries attending the MEMORIAL SERVICE register with us so that we may accommodate you and the apparatus/vehicles you plan to bring to honor our fallen brother.
Please fill out the pertinent section(s).

DEPARTMENT / AGENCY / ORGANIZATION
Department / Agency / Organization Name*
Type of Department or Agency*
"Other" Agency/Organization Description
Chief of Department or Leader of Agency*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
RANKING DIGNITARY REPRESENTATIVE ATTENDING
Ranking Representative*
Rank/Title First Last
Rep's Phone*
Rep's Email*
Total Number of Dignitary Staff Vehicles*
NUMBER of vehicles coming only, NO TEXT PLEASE
Total number of additional Agency or Dignitary Representatives Attending (exclusive of Apparatus/Pipe/Drum Corps personnel)
NUMBER of people coming only, NO TEXT PLEASE
ADDITIONAL AGENCY or DIGNITARY REPRESENTATIVES ATTENDING
Type in the name(s) of your accompanying Dignitaries if you would like. These representatives must be included in the total above.
Rank/Title First Last
Rank/Title First Last
Rank/Title First Last
Rank/Title First Last
Rank/Title First Last
Rank/Title First Last
Rank/Title First Last
Rank/Title First Last
Rank/Title First Last
Rank/Title First Last

Memorial Logistics Website Courtesy of
www.LosAngelesCountyFireMuseum.com

LINE OF DUTY DEATHLast Alarm: June 25, 2018

FIRE PERSONNEL – DIGNITARY – VIP REGISTRATION

Registration for Captain David Rosa's Celebration of Life

DEPARTMENT / AGENCY / ORGANIZATION

RANKING DIGNITARY REPRESENTATIVE ATTENDING

ADDITIONAL AGENCY or DIGNITARY REPRESENTATIVES ATTENDING

LINE OF DUTY DEATH
Last Alarm: June 25, 2018