If there any changes to this information after you submit the form, please call the Honor Guard Manager at (540) 665-5618.

1

Type of event:

 *

Type of event:

2

Indoor or outdoor:

 *

Indoor or outdoor:

Indoor

Outdoor

3

Name/rank of individual:

 *

Name/rank of individual:

4

Location:

 *

Location:

5

Address:

 *

Address:

6

Date:

 *

Date:

7

Day of the week:

 *

Day of the week:

8

Time:

 *

Time:

9

Requesting organization:

Requesting organization:

10

Name:

 *

Name:

11

Phone:

 *

Phone:

12

Fax:

Fax:

13

Honors requested:

 *

Honors requested:

Post and retire colors

Post only

Present colors

Flag fold

ONLY FCFR approved script is allowed to be read during the flag folding ceremony. Honor Guard presents flag to Retiring Official. Retiring officials message to Retiree: "(Rank and Name,) on behalf of (Shift / Assignment), your friends and your family, I present this flag in recognition of your [number] years of faithful service with the Frederick County Fire and Rescue Department."

14

Additional comments:

Additional comments:

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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