Join SoCal FSS Mailing List!
Sign up and get regular updates from SoCal Families for Safe Streets. As individuals who have lost loved ones or been injured in traffic crashes, SoCal Families for Safe Streets offers support and opportunities for action to people who share our unique grief.
Sign in to Google to save your progress. Learn more
Name *
Neighborhood or City *
E-mail *
Phone Contact
Organization/Group (if any)
Your story
Only if you are comfortable, please share with us any information regarding your crash or the victim's crash. We use this data to send memorial cards and connect members with other members who may have similar experiences.
Victim Name
Relations with Victim (i.e.: mother of victim)
Date of Incident
MM
/
DD
/
YYYY
Any Comments?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Los Angeles Walks. Report Abuse
Google Forms