Gold Star Family Members
 Yes, I want to be added to your list so that I can be contacted about the Memorial Service, Officer Appreciation Dinner and any major event effecting a friend in law enforcement.
 (The Quad Cities Law Enforcement Officers Memorial keeps my info strictly in house and does not share, sell or provide the information to others).
First Name
Last Name
Email Address
Phone
Cell Phone
Address
City
State
Zip Code
Comments
Relationship to Officer
 
Q.C.L.E.O.M.
For a limited time... Drawing for Gold Star Familys that completes form. 1 in 5 will receive a 10th Anniversary Challenge Coin!