To request assistance for a public safety officer or firefighter, the appropriate form must be completed by a supervisor or human resource personnel.  Potential beneficiaries are not authorized to submit requests.

Line of Duty Injury:

To receive benefit information and request a benefit form please email ramsey@100club.org with a brief description of incident.

Line of Duty Death / Non-Line of Duty Death Benefit Request Forms:

·         Download (PDF) Version

 *If you have not received a phone call from a 100 Club representative within 24 hours after submitting your request, please call our office at 602-485-0100 to verify that we have received the paperwork.

Benefit Questions, E-mail: ramsey@100club.org