TPOM Honored Surviving Family and Affected Co-Worker Registration 2023

Agenda

The Texas Peace Officers’ Memorial Weekend is April 29 & 30, 2023
Event Check-In is at 10 am Saturday, April 29, 2023,
Orientation is on Saturday, April 29, 2023, and attendance is required to participate
Texas Peace Officers’ Memorial Ceremony is the evening of Sunday, April 30

Reserve your rooms at the Hilton Austin HERE -

Honored Officer Information -

Honored Officer's Name

Title/Rank

Date of Death/End of Watch

Please Select

Agency

County

Are you a Returning Survivor?

Your Name

Title/Rank

Mobile Number

* you may receive text updates the day of the event, carrier charges may apply.

Address

City, State and ZIP Code

Your relationship to your Fallen Officer. I am their:

Names of others attending who are part of your family and also reside at the address above:

Please Note: Stage Seating on the Capitol is limited per officer

Attendee 2 Name

Relationship to Officer - Attendee 2

Attendee 3 Name

Relationship to Officer - Attendee 3

Attendee 4 Name

Relationship to Officer - Attendee 4

I have more attendees to add

Survivors’ Dinner – Saturday, April 29

Number of Adults Attending Dinner -

Number of Children attending Dinner -

Please list first and last names of all those attending the dinner here -

Do any of your attendees have a food allergy?

Do you have additional meal requirements, based on faith, medical or other

Texas Peace Officers’ Memorial Ceremony – Sunday, April 30, 2023

Number attending Memorial -

Additional Comments/Requests

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