Request a Service – Wisconsin Nurses Honor Guard

COVID-19 UPDATE (5/31/20): The ability to perform in person tributes will be assessed on a case by case basis, as regulations may differ from county to county. Please understand that our members will be wearing masks for any in person tribute. Thank you.

Name of Family Member or Primary Contact Who Is Organizing the Service *

First

Last

Those requesting the service need to be either a family member, clergy, funeral director, or other individual directly involved with the funeral planning of the fallen nurse.

Primary Contact Person's Email *

Primary Contact Person's Phone Number *

Name of Nurse We Are Being Asked to Honor *

First

Last

All information from here to the bottom of the form pertains to the nurse that we are being asked to honor. Please provide the appropriate answer (if known) with the honoree's details. Thank you.

Nurse's Credentials

Name and Location of Nursing School Attended

Year of Nursing School Graduation (if known)

Year of Retirement (if applicable)

Date and Time of Memorial / Funeral Service *

Expected Honor Guard tribute time? *

What time do you want the 10 minute Honor Guard tribute performed? Please note that we arrive 30 minutes before and depart immediately after the tribute and we therefore require specific scheduling in order to meet these times.

Name and Phone # of Funeral Home Contact

Location of Service (Address) *

Share a special nursing story with us about the Honoree

Acknowledgement *

Please Note! When requesting an Honor Guard service, you understand that we are volunteers. Attendance of WNHG members at any service is based on member availability and our presence is therefore not guaranteed. Please type "I agree" if you agree and understand this.