Please use the following web form to submit a death report for a member of your chapter. We will use this information to extend assistance to the surviving spouse of the member and acknowledge their passing in our monthly TAPS listing in the magazine. Additionally, we appreciate your help in keeping our member records up to date.

We will send an email to confirm receipt of your report and we encourage you to contact us if there is any way that we can help the family of your chapter member. We are available at 1-800-234-6622, Monday through Friday, 8AM until 6PM, EST.

Deceased Member's Information * Required field * Required if requesting TAPS magazine listing
* First Name:
Middle Initial:
* Last Name:
National MOAA Member Number:
* Rank:	Select Rank 1LT 1stLt 2LT 2ndLt ADM ASG AST BG BGen BrigGen CAPT CDR Col CPT CW2 CW3 CW4 CW5 CWO2 CWO3 CWO4 CWO5 DIR DSG ENS FULL Gen LCDR LT LTC LtCol LTG LtGen LTJG Maj MajGen MG Miss Mr. Mrs. Ms. RADM SAST SGEN SR VADM WO1 None
* Service:	Select Service USA USMC USN USAF USCG USPHS NOAA None
* Status:	Select Status Active Former Retired
* Street Address 1:
Street Address 2:
* City:
* State:	--Select One-- AA AE AK AL AP AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY
* ZIP Code:
Date of Death:

Surviving Spouse's Information * Required field
*Is there a surviving spouse?
Yes No Unknown
First Name:
Middle Initial:
Last Name:

Surviving Spouse Address (only needed if different from deceased)
Street Address 1:
Street Address 2:
City:
State:	--Select One-- AA AE AK AL AP AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY
ZIP Code:

Reporter's Information * Required field
* Does the member's family wish to have the member's name listed in TAPS?
Yes No Unknown
Chapter Name:
Your Name:
* Your Email:
Your Contact Phone Number:
Comments: