Monument Application 9/11 Benefit Fund
The Washingtonville - Blooming Grove 9/11 Benefit Fund is constructing a monument in memory of the growing number of 9/11 rescue and recovery workers who have lost their lives to post 9/11 illnesses. To have a name placed on this monument, the person being honored had to have lived within the Washingtonville School District OR the Blooming Grove Township on 9/11/01 or the time of their passing. If you have a loved one who did not live within this parameter, please email us at WBGNY@gmail.com and we will try and help you locate the appropriate township. If you have someone you would like to be honored on this monument please answer the following questions to the best of your knowledge. Documentation may be requested to verify information after you submit your application.
Sign in to Google to save your progress. Learn more
Contact Name *
Contact Phone Number
Contact Email *
Contact Address *
Honoree Name *
Did the honoree reside within the Blooming Grove township or Washingtonville Central School district on 9/11/01 or date of passing? *
Did the honoree pass from 9/11 related illness? *
Was the honoree registered with the World Trace Center Victim Compensation Fund? *
Was the honoree a member of one of the following organizations? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms