Honoree Application NEMSMS only

"*" indicates required fields

NEMSMBR participants memorialize these Honorees during the Routes by:
  • Reading the names of the Honorees each day at memorial services;
  • Carrying dog tags and biographical information of the Honoree throughout the events, either while cycling or performing various logistical support roles;
  • Sharing dog tags with family -- or colleagues -- of the Honoree during the Route, or upon conclusion of the event;
  • Sharing with one another the unique qualities and details of each Honoree's accomplishments and sacrifices to the profession; and
  • Displaying biographical information publicly in a "traveling temporary monument" in cities across the country.
Submission for 2024 Routes are open. To request that a person who's End of Service is by December 31st, 2023 and to be honored in our 2024 events, please complete the form below by January 31, 2024.

Honoree's Information

Name of Honoree*
This field is hidden when viewing the form
example: ROO-bee (Ruby) or VAY-duh (Veda)
Date of Birth*
EMS Cerification(s)*
Please select the closest certification.

Please choose ONE affiliation.
Date of Death*
Do you plan to submit this individual to the National EMS Memorial Service? (This is NOT a submission to the National EMS Memorial Service)*
Link for more information: National EMS Memorial Service
Please use the name of the honoree in the file name.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 50 MB.
(i.e. hobbies, surviving family, awards they’ve received)
Provide a website link to an obituary.

Submitter's Information

Submitter's Name*
Submitter's Email*
Relation to Honoree*
Condolence Card Request (optional)
The National EMS Memorial Bike Ride would like to send notes of condolences whenever possible to surviving family members and colleagues. This will serve to remind the family members of the mission of the Ride, and of our interest in honoring their loved one.