Retirement Shadow Box Form
IAFF Local 1159
Name as you would like it on your plaque
First Name
Last Name
Rank or Title (Optional)
Date of Hire and Retire for Plaque (Specific date or month of hire and retire)
Hire
Retire
Phone Number
Please enter a valid phone number.
Email
example@example.com
Type of Wood
Please Select
Walnut
Alder
White Oak
Red Oak
Stain Shade
Please Select
Light
Medium
Dark
Black
Any Other Details or Notes?
Please contact Secretary Nate Hon for any questions. 503-764-5777, Secretary@local1159.com
Submit
Should be Empty: