Portrait Request Form

Portrait Request

To request art work of a Missouri Fallen Officer

Name Of Fallen Officer
First Last
End Of Watch Date
Fallen Officer's Department at EOW
Fallen Officer's Rank at EOW
Hero's Eye Color
Hero's Hair Color
Requesting Family Member Name
First Last
Requesting Family Email Address
Requesting Family Member Mailing Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Requesting Family Member Primary Phone
Requesting Family Member Alternate Phone
Notes
SUBMISSION REQUIREMENTS per Artist Neal Slaten: I require 3 to 5 color digital images (or prints) of your fallen hero. Images in uniform are not necessary if not available or desired. Prints, if sent, will be returned to you with the completed portrait. Face & Head images are especially important. The quality of the finished portrait depends on the quality of the photos you send me. All portraits are Oil Paintings approximately 12 x 16 inches of the Head and Shoulders only.

Missouri Concerns of Police Survivors