Project: Hollywood Cares -Family Request

Families of Fallen Heroes Request Form

Carefully selected gift boxes, programs, and toys and gifts are sent or presented to the surviving spouse and dependents of fallen heroes who have made the ultimate sacrifice while participating in Operation Iraqi or Enduring Freedom.

Important: Military address information is confidential and Project: Hollywood Cares does not share this information with any other parties.

Fallen Hero Information

	(All fields are required.)

	First Name
	Last Name
	Rank/Rate:
	Branch of Service
	Hometown
	Location of Loss
	Name of Spouse
	E-mail
	Address 1
	Address 2
	City
	State
	Zip Code
	Number of Children
	Range of Children's Ages

TV/Music Preference and Favorites:

Person Making Request

	(All fields are required.)

	First Name
	Last Name
	Relationship to Family
	E-mail
	Address 1
	Address 2
	City
	State
	Zip Code