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I understand that this restricted site is intended for the private use of and safe exchange of information among adult (18 years of age and older): survivors who have been affected by the death of a person whose life included military service as well as volunteers and supporters of TAPS.

I Am A

Survivor

Supporter

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First Name

Last Name

Title / Rank

Preferred Name

Address

Address 2

City

State

Zip

Cell/Phone

Preferred Contact

Phone

Text

Age Category

Adult

Child

Date Of Birth

Military Service

Branch Of Service

Duty Status

Home (Or Last) Station

Military Service End Date

Civilian Position

Professional Certification

	Educator
	Medical Professional
	Mental Health Professional
	Other

Tell us about your Loved One: (If you have experienced multiple military losses, please list most recent first. Your account can hold information for up to three Loved Ones.)

Loved One Was MY

Loved One's Rank/Title

Loved One's First Name

Loved One's Last Name

Loved One's Branch Of Service

Loved One's Duty Status

Loved One's Last Station

Loved One's Cause Of Death

Loved One's Date Of Death

TAPS SIGNATURE CERTIFICATION

By accepting the terms of the agreement and typing full name in the electronic signature below, I verify that the personal information I provide to TAPS is accurate and agree to abide by any and all restrictions set forth on this site, including, but not limited to the "Terms" of use. Furthermore, I agree that I will not use the TAPS Portal and Online Community to attempt interviews with group members for research or other purposes. I will maintain all conversations in a supportive, respectful, and compassionate manner, and will refrain from engaging in divisive topics (i.e., politics, religion).

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