POLICE UNITY TOUR
Chapter I
2016 Memorial Bracelet Order Form
Each member is strongly encouraged to purchase a Memorial Bracelet with the name of an officer who died in the Line of
Duty! It is an unfortunate fact that on average of 150 law enforcement officers who die in the line of duty annually. Since the Police Unity
Tour has grown to over 1800 participants annually it is important that we not only honor those from the preceding year but we never
forget and honor those who made the ultimate sacrifice long before the Police Unity Tour started the Memorial Bracelet Program.
Please take a few minutes do some research on historical line of duty deaths on the National Law Enforcement Officers Memorial website;
http://www.nleomf.org/officers/search/ and honor one of these fallen heroes.
Once you have chosen a fallen officer it is your responsibility to contact the fallen officer’s department to inform them about the Police
Unity Tour and request assistance in making arrangements to meet the officer’s family and/or department members at the Memorial and
present the bracelet to them. If they are unable to meet you, the bracelet should be sent to them upon completion of the Tour.
Fallen Officers Information
Name:
Rank :
Agency:
Agency State:
E.O.W.:
I agree to be randomly assigned a fallen officer who made the ultimate sacrifice in 2015.
Orders will not be processed until payment is received!
Bracelet Type
Quantity
Price Per Bracelet
Total
$ 15.00
Blue Memorial Bracelet
$ 65.00
Silver Memorial Bracelet
Office Use Only!
$ 2.95
Shipping Charges (if applicable)
If you choose to have your order shipped to you there will
TOTAL
be a minimum shipping charge of $2.95
$
Please note the prices on all bracelets are subject to change based on the cost of the material.
We recommend that you
order a duplicate bracelet if
you would like to keep one
for yourself.
Orders can be placed as follows:

Mail:
Police Unity Tour Inc.
Attn: Bracelets
P.O. Box 528
Florham Park, NJ 07932

Fax:
(973) 443-0808
Anyone faxing an order form must follow-up the fax with a phone call; (973) 443-0030
and / or email; [email protected] to ensure the fax was received.

E-Mail [email protected]
I agree to pay the applicable shipping charges, please charge my account below.
Deadline for ordering Memorial Bracelets is March 15
Last Name:
First Name:
MI:
Method of Payment (Check one)
Home Address:
City:
Phone Number:
State:
Zip:
Amex
E-Mail Address:
Discover
Agency:
Card / Check #
Print name as it appears on card:
Card Verification Code:
Signature:
Make checks or money orders payable to the Police Unity Tour.
Please No Cash!
Any questions should be directed to [email protected]
Visa
Expiration Date:
Other
MasterCard
Check
Credit Card Billing Zip Code:
Date:
**** Office Use Only! ****
Order Processed by __________ on _____/_____/_____
Revised 7/9/15